Paper 19/32 23 May 2019 Page 1 of 84

Oxfordshire

Clinical Commissioning Group

OXFORDSHIRE CLINICAL COMMISSIONING GROUP BOARD

Date of Meeting: 23 May 2019 Paper No: 19/32

Title of Paper: OCCG Annual Report 2018/19

Paper is for: (please delete tick as appropriate) Discussion Decision Information

Conflicts of Interest (please delete tick as appropriate) No conflict identified Conflict noted: conflicted party can participate in discussion and decision Conflict noted, conflicted party can participate in discussion but not decision Conflict noted, conflicted party can remain but not participate in discussion Conflicted party is excluded from discussion Purpose and Executive Summary: The following paper includes the Performance Report and the Accountability Report sections of the Annual Report for 2018/19. The Performance Report must consist of:

• A summary that provides the public with information to understand the organisation, its purpose, key risks, objectives, achievements and how it has performed in the year.

• A performance analysis – to report on the organisations most important performance measures.

The Accountability Report must consist of:

• A corporate governance report • A Remuneration and Staff Report • A Parliamentary Accountability and Audit Report

The Annual Report will be submitted to NHS England by Tuesday 28 May. To note, there are still some outstanding performance and finance figures which will be included in the final draft.

Engagement: clinical, stakeholder and public/patient: Not applicable

Paper 19/32 23 May 2019 Page 2 of 84

Financial Implications of Paper: Not applicable Action Required: To approve the report on the basis of a detailed review by the audit committee.

OCCG Priorities Supported (please delete tick as appropriate) Operational Delivery Transforming Health and Care Devolution and Integration Empowering Patients Engaging Communities System Leadership

Equality Analysis Outcome: Not undertaken although it reports on the actions the CCG takes to ensure equality.

Link to Risk: Not Applicable

Author: Sarah Adair, Head of Communications an Engagement, sarah.adair@nhs.net

Clinical / Executive Lead: Catherine Mountford, Director of Governance, catherine.mountford@nhs.net

Date of Paper: 15 May 2019

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Oxfordshire Clinical Commissioning Group: Annual Report 2018/19

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Foreword I am delighted to present Oxfordshire Clinical Commissioning Group’s (OCCG) annual report and accounts for 2018/19. The report describes activities that we have undertaken over the past year. This is my second year as Clinical Chair of OCCG. As a clinically led organisation we continue to work tirelessly to innovate and work with NHS, social care and voluntary sector partners to improve and provide new services locally for all people living in Oxfordshire. During the year we have made real progress in the way healthcare is delivered in the county. The primary care visiting service, as well as the new advanced nurse practitioner outreach pilot are providing care for people in their own homes and helping to stop hospital admissions. Clinicians in Oxfordshire are pioneering new approaches to reduce the mortality rate of babies; we are achieving better diabetes outcomes and improving cancer detection. We are investing in perinatal mental health support and have extended mental health support for people in crisis over the weekend when traditional services have not always been available. We have continued to improve access to GP appointments. This includes continuing to invest in extended access hubs for primary care which allows patients to get an appointment in the evenings and weekends. As a local GP, I know how important this is to my patients. I also know that GP practices across Oxfordshire are working incredibly hard to meet the increasing needs of patients that we care about very much. This year there has been a real focus on developing how we work better together with all our partners across the NHS and social care; yet we must do more. Demand for health and social care services is increasing year on year. To face this challenge head on we need to continue to work together to implement the NHS Long Term Plan. We will continue to put patients and the public at the centre of what we do; to do this we will use a more ‘place-based’ approach for planning and providing health and care. This means working with the local residents, communities and stakeholders, including local councils, to determine the needs of that community and to develop services that respond to that need. This work has already started in the south of the county. I would like to thank all our partners across the system who work so hard to provide high quality care to patients. OCCG will continue to be committed to working with them. Together, we will strive to offer care in the right place at the right time to prevent ill health and keep people living well and independently for longer. Dr Kiren Collison, Clinical Chair

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Contents

Performance Report 4

Performance Overview 4

Performance Analysis 6

Accountability Report 39

Corporate Governance Report 39

Members Report 39

Statement of Accountable Officer’s Responsibilities 45

Governance Statement 47

Remuneration and Staff Report 61

Parliamentary Accountability and Audit Report 75

Independent Auditor’s Report 76

Glossary of Terms 77

Appendix A: Table of Attendance for Board and Committee Meetings 80

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Performance Report ‘By working together we will have a healthier population, with fewer inequalities, and health services that are high

quality, cost effective and sustainable.’

Performance Overview OCCG is the statutory organisation in Oxfordshire that plans, buys and oversees health services for more than 720,000 people from a range of NHS, voluntary, community and private sector providers. OCCG is responsible for commissioning non-specialist hospital services, both urgent and planned care. As well as commissioning GP services, mental health and learning disability services, ambulance services and community services such as district nursing and physiotherapy. Specialist hospital services, dentistry and optician services are commissioned by NHS England (NHSE). OCCG is a member organisation of 70 GP practices in Oxfordshire; we work with local people, GPs, hospital and community service providers and other partners including local government and voluntary sector organisations. OCCG’s main health and social partners are Oxfordshire County Council (OCC), local District Councils, GPs and GP Federations1, Oxford University Hospitals NHS Foundation Trust (OUH), Oxford Health NHS Foundation Trust (Oxford Health) and South Central Ambulance NHS Foundation Trust (SCAS). OCCG has a duty to improve the quality of services commissioned; reduce health inequalities; involve the public and patients in commissioning decisions and deliver a Health and Wellbeing (HWB) Strategy. This Annual Report describes how OCCG carry out its duties. A new Oxfordshire Joint Health and Wellbeing Strategy (2018 – 2023) was developed during 2018. Coordinated by OCC and OCCG the new strategy was produced with input from the public, voluntary sector and health and social care partners. It aims to

• 1 OxFed coveris Oxford City; Principal Medical Limited (PML) which covers the North (NOxMed), North East (OneMed), West (WestMed) and part of the South West (ValeMed) localities in the county; Abingdon Federation (covering the remainder of the South West locality) and SEOX (South East Oxfordshire Federation).

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improve the health and wellbeing of local people and reduce health inequalities across the county (see page 8). This strategy will guide the work of OCCG over the coming years alongside our local implementation of the NHS Long Term Plan.

Oxfordshire’s Population

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The information above is from the Joint Strategic Needs Assessment for Oxfordshire 2019 which provides information about the county’s population and the factors affecting health, wellbeing, and social care needs. It brings together information from different sources to create a shared evidence base. This informs OCCG’s strategy and supports its service planning and decision-making. To read more about the health needs of Oxfordshire’s population visit Oxfordshire County Council website: http://insight.oxfordshire.gov.uk/cms/joint-strategic-needs-assessment.

Performance Analysis Overview of Performance from Louise Patten – Chief Executive This year a key focus for OCCG has been how the health and social care system works better together in Oxfordshire for the benefit of local people. Our main achievements, and indeed challenges, are set out in this report but I want to highlight a few which, I believe, will have a positive effect on patients and continue to build a stable and sustainable health and social care system in Oxfordshire. Significant work has been done to join up services across Oxfordshire which are already demonstrating improved outcomes for people. This was reflected in the Care Quality Commission (CQC) follow-up review of the Oxfordshire system. I was really pleased to see that the CQC recognised the significant improvements in our work as system leaders to reset the culture of our organisations and plan in a more joined up way. I am also delighted to say that we have remained in financial balance with a small surplus of £16,000. This is a significant achievement given the challenges facing the NHS nationally and the demand for healthcare increasing every year. Our surplus will added to the CCG’s historic surplus of £23.4m and be returned to us to invest in patient services in future years. We took a new approach to tackling the growing pressures of winter on the NHS and social care this year. Together, the NHS and OCC appointed a Winter Director to lead a central team from the NHS, social care and voluntary organisations to reduce seasonal pressures and improve quality and performance of emergency and urgent care. Headline improvements with this way of working include a 9% increase in acute hospital discharges compared to the previous winter with an overall reduction in length of stay and there were no 12 hour A&E trolley waits. While as a system we have struggled to meet the national four hour wait target in our main A&E departments, they have been met in the minor injuries units across the county.

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This past year has seen Oxfordshire’s health and social care system partners agreeing a new approach to planning health, care and wellbeing services using ‘population health management’. A framework, agreed by the Oxfordshire Health and Wellbeing Board, will be applied to each locality by working in a new way with residents, communities and stakeholders, including local councils. The first area to benefit from this new approach is the OX12 postcode (Wantage and Grove and surrounding villages). The same approach will be used in a number of areas in Oxfordshire during 2019/20. We are investing more in the detection and prevention of Type 2 diabetes with the national NHS Diabetes Prevention Programme; a service designed to stop or delay the onset of the disease. OCCG was successful in bidding for funding for several projects to introduce new mental health services this year. Children and young people in Oxfordshire will get better access to mental health services after the county was chosen, by the Government, as an NHS 'trailblazer site' and awarded £5.4m in extra funding until 2021. In addition, £800,000 was secured for a new specialist perinatal mental health service for women who have mental health problems during or after their pregnancy. In early 2019, NHS England published the NHS Long Term Plan that set out the challenges ahead and the priorities for the NHS. We have already started work to deliver this plan with our GP practices to develop Primary Care Networks (PCN). These networks will offer services on a scale which is small enough for patients to get the continuous and personalised care they value, but large enough – in their partnership with others in the local health and care system – to be resilient and sustainable. They will ensure more equity across the county for primary care services so all patients’ benefit regardless of which practice they are registered with. Considerable work has been undertaken this year across the system to ensure we are working better to improve outcomes for patients. This work will continue into 2019/20 through integration of services as we strive to offer seamless, high quality care in the right place and at the right time.

Louise Patten

Chief Executive

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Improving the health and wellbeing of people in Oxfordshire During 2018/19, OCC and OCCG worked with partners to revise and ‘rejuvenate’ the structure and responsibilities of the Oxfordshire Health and Wellbeing Board to support the development of a more collaborative and integrated approach to health and social care in Oxfordshire. A new Integrated System Delivery Board is part of the new structure. Membership includes health and social care providers and commissioners and its main functions are to:

• Deliver the Health and Wellbeing Board’s vision for integrated health and social care in Oxfordshire • Develop a single system plan and move towards an integrated health and care system.

Part of this work has been to refresh the Oxfordshire Joint Health and Wellbeing Strategy (2018 – 2023). The strategy is all about people who live in, work in and visit Oxfordshire and tells the story of how the NHS, councils and Healthwatch work together to improve health and wellbeing. The strategy has been developed with input from the people of Oxfordshire; during 2018 there was wide engagement in the development of the new strategy with a focus on the Good Start in Life (Children’s section) and the Ageing Well (Older People’s section), followed by a consultation in January 2019.

New approach to planning health and care launched in Oxfordshire As part of the delivering the Oxfordshire Health and Wellbeing Strategy, the county’s health and care partners have agreed a new approach to planning health, care and wellbeing services using ‘population health management’. OCCG worked with partners to develop a framework to review and plan for future care needs in the county. The framework has been agreed at the Oxfordshire Health and Wellbeing Board (HWBB) and is intended to be delivered by working in each locality with the local residents, communities and stakeholders, including local councils. Plans developed will be based on the needs of that community and will recognise the assets that already exist in the community. The first area to benefit from this new approach is the OX12 postcode (Wantage and Grove and surrounding villages). The framework is based on using population health management, an approach that features in the NHS Long Term Plan. It aims to improve physical and mental health outcomes, promote wellbeing and reduce health inequalities across an entire population. Its partnership approach focuses on prevention and understanding the wider factors that affect people’s health, as well as developing quality services and support when and where they are needed. While every person has unique requirements and circumstances, working at scale across a whole population identifies groups with similar health and care needs and characteristics.

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We are working to achieve this through the OX12 area by creating an evidence base that includes an analysis of the health and care profile of the local area. This information will help us plan and deliver services in the most appropriate ways and in the most convenient places.

CQC notes improvements in health and social care working Significant work has been done to join up services across Oxfordshire that is already demonstrating improved outcomes for people, according to a follow-up review by the national regulator for health and social care published in January 2019. The Care Quality Commission (CQC) found key improvements had been made eight months into an 18-month action plan that was agreed by Oxfordshire health and social care organisations after an initial review by the CQC in November 2017. Following the first review, a key priority for system leaders has been to work more closely together to plan and deliver health and social care services, particularly for older people. Senior managers have used their learning from Winter 2017/18, creating a system approach that has significantly improved joined-up working across NHS and Local Authority partners (see page 21 for further details). As part of delivering the Oxfordshire Health and Wellbeing Strategy, health and care organisations have also been working together to improve patient flow through the system to reduce ‘delayed transfers of care’, so that patients who are physically well enough to leave hospital do so at the appropriate time (see page 21).

Developing Primary Care Networks The NHS Long Term Plan (LTP) has set an ambitious programme of change for primary care and community services. OCCG has received funding from NHS England of around £600,000 to accelerate the development of the neighbourhoods / Primary Care Networks (PCN). OCCG, in common with other clinical commissioning groups across England, is encouraging all GP practices to become part of a local PCN. These are based around a GP registered list of approximately 30,000 – 50,000 patients, including GP practices and other partners in community and social care. These networks offer services on a scale which is small enough for patients to get the continuous and personalised care they value, but large enough – in their partnership with others in the local health and care system – to be resilient and sustainable. OCCG currently has 17 Neighbourhoods across the Oxfordshire footprint which will form the basis of the Long Term Plan PCNs.

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Primary care visiting The primary care home visiting and support teams assist GPs to respond to requests for urgent same day home visits. The aim is to provide a more responsive service, to visit in a timely manner rather than waiting until a GP has finished their appointments session. The service aims to identify the need for early support before a patient’s condition deteriorates and they need to be admitted to hospital. The service is made up of a team of emergency care clinicians such as nurse practitioners and community paramedics who provide urgent home visits to older and housebound patients, people in care and nursing homes, and those in rural areas. The primary care visiting service is available across most of the county and in 2018/19 carried out 12,452 visits.

GP services at Cogges Surgery in Witney In July 2018 the GP partners at Cogges Surgery in Witney gave six months’ notice to hand back the contract they held for providing primary care services to around 7,700 people in the town and some surrounding villages. Increasing workload demands and challenges in maintaining high quality services, together with concerns over the future of smaller practices all contributed to difficulties recruiting new GP partners. OCCG was keen to find a local solution for patients registered at Cogges to keep services running from the surgery. OCCG responded promptly in establishing a 'light touch' procurement process to find a local practice to continue providing services. OCCG received more than one expression of interest and put together a selection process for these applications. Patients were kept informed early in the process: a dedicated section of OCCG’s website was set up to keep patients and stakeholders updated and a Stakeholder Reference Group was established. During the process the GP partners at Cogges informed OCCG that they had continued their efforts to recruit a new partner and had been successful. As such they wanted to continue to continue with their contract. OCCG asked the partners to complete the same process as the other potential providers. They were successful and OCCG agreed the continuation of the contract; meaning that the current team continues to deliver primary care to their patients. This decision was widely supported by patients and the neighbouring practices in West Oxfordshire. The engagement of patients in the whole process was widely commended by the local community and stakeholders.

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Extended hours access hubs GP access hubs in Oxfordshire continue to offer people routine appointments to see a doctor or practice nurse at the weekend or in the evening. Access hubs are provided by the four GP Federations in Oxfordshire:

• OxFed covering Oxford City • Principal Medical Limited (PML) which covers the North (NOxMed), North East (OneMed), West (WestMed) and part of the

South West (ValeMed) localities in the county • Abingdon Federation (covering the remainder of the South West locality). • SEOX (South East Oxfordshire Federation).

In 2018/19, extended access hubs offered 78,947 extra routine appointments over and above those available in practices. A patient calls their own GP practice to make the extended hours appointment. Practice staff will book available appointments, which may not be at the patient’s own practice but will be at a nearby surgery. The service allows patients to get an appointment at a time which suits them, reducing waiting times. It also frees up practice time for GPs to see more vulnerable patients, especially older people who may prefer to see their ‘named’ GP, reducing the risk of them being admitted to hospital. Extended hours access hubs are a key part of winter planning.

Introduction of an integrated respiratory team in the community In November 2018 OCCG launched an Integrated Respiratory Team pilot project to support patients with long term respiratory conditions such as Chronic Obstructive Pulmonary Disorder (COPD) and asthma. The project enhances existing community, hospital-based and primary care services by providing a consultant to work in the community alongside additional respiratory nurses and physiotherapists working with respiratory GPs, a dedicated psychologist, a pharmacist, dedicated smoke-free advisor from with Smokefreelife Oxfordshire, (the county council's stop smoking service partner) and a specialist in palliative care support. The project is being staffed by NHS clinicians and other professionals from OUH, Oxford Health and local GPs. Patients in Banbury, Chipping Norton and Oxford City are taking part in the pilot, which is also being supported by pharmaceutical company Boeringher Ingelheim.

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The initiative will improve all round patient care - including mental health support and end of life care. More care is being provided for patients in their own home or closer to home via GP practice-based specialist clinics. Patients are also being supported to manage their conditions better which will have a direct and positive impact on their overall health. Better outcomes for patients will mean fewer hospital admissions and a reduction in treatment costs. If the pilot project is successful, it could lead to the service model being established across the whole of Oxfordshire.

Suspected CANcer (SCAN) Pathway Many patients visit their GP with 'vague' symptoms such as weight loss and tiredness. These symptoms are called 'non-specific' as they affect the whole person. Often the cause of these symptoms remains unclear after GP assessment. While there is commonly a minor cause for such symptoms, there is a small chance that they could be the signs of a serious illness, such as cancer. Before the launch of the SCAN pathway two years ago, GPs did not have a way to get rapid investigations for patients with 'non-specific' symptoms, with patients going back and forth between their GP and the hospital many times until a diagnosis was made. Although the risk of serious disease is low, a delay in diagnosis and treatment can have a negative effect on the patient’s health. The SCAN pathway aims to lower the referral threshold for suspected cancer and help those patients with ‘non-specific’ symptoms. It involves rapid access to Computed Tomography (CT) and laboratory tests (blood and faeces tests), with possible further tests if needed. The aim is to reach a diagnosis and begin treatment faster than previously happened. Between 4 April 2017 and 28 January 2019 the service has received 1,260 referrals, with an average of 20 referrals per week. Of 1,063 eligible patients as at 28 January 2019, 942 had been through the SCAN pathway. This resulted in 92 confirmed cancer diagnoses making the Oxfordshire SCAN cancer detection rate at 10.2% which is higher than the national rate of 7.3%. A number of serious but non-cancer diagnoses have also been found through the investigations undertaken as part of the pathway including: heart failure, coronary artery disease; Addison’s disease; and hernia. OCCG has been working hard with OUH to improve cancer waiting times; five out of the eight constitutional targets were met (see page for more 37 for more detail on performance figures). We will continue to work with OUH to develop and implement a plan to improve cancer waiting times over the next year.

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MSK physiotherapy and assessment services In October 2017 Healthshare Oxfordshire took over the provision of musculoskeletal assessment and therapy services for NHS patients across Oxfordshire. Musculoskeletal problems, also known as MSK, cover a broad range of joint, muscle, soft tissue injury or back pains that do not resolve on their own or with simple self-management. Referrals range from minor injury to significant and debilitating conditions, some of which require onward referrals to secondary care services. This service, with its assessment and MSK physiotherapy focus, has responded to high demand, receiving referrals mainly from GP practices which averaged 5,206 referrals per month between June and November 2018. This was much higher than expected and planned for. Feedback from patients directly to Healthshare and OCCG, a HealthWatch report and a review of the service transition undertaken by the MSK Service Task and Finish Group of the Oxfordshire Joint Health Overview and Scrutiny Committee (HOSC), has provided a patient-focused response highlighting areas for improvement. OCCG has worked with the service to establish an action plan to strengthen current capacity, through an increase in staffing, streamlining of administrative processes and improvements to phone call response times. This continuing service improvement has successfully reduced waiting list numbers, with XX. Further work is underway to shorten average wait times with priority being given to urgent referrals. In patient satisfaction surveys, 84% of people responding said that they were likely to recommend the service to family and friends. Since February 2019, patients have also been able to self-refer without a GP. This has been well received by both patients and GPs.

Improving diabetes care and prevention It is estimated that around 56,000 people in Oxfordshire are currently at risk of developing Type 2 diabetes which can lead to other serious conditions including strokes, heart diseases, limb amputation and early death. However, in most cases it is preventable and also reversible if caught early. In June 2017 OCCG introduced the national NHS Diabetes Prevention Programme. This local service for people who are at risk of Type 2 diabetes is designed to stop or delay the onset of the disease through a range of personalised lifestyle interventions,

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including education on lifestyle choices, advice on weight loss through healthier eating and bespoke physical activity programmes. Since June 2017, 2,988 people have been referred into the programme, with 1,251 people already starting the 10 month course. Extra investment has also been put into a number of initiatives to support the 30,000 (circa) people with diabetes in the county (Type 1 and Type 2 combined; about 10% have Type 1 and about 90% have Type 2). The initiatives include:

• Development of GP practice diabetes multi-disciplinary team consultations where a diabetes consultant and community diabetes specialist nurse attend the practice to meet with lead GP and practice nurse to review care and share good practice.

• Support to increase the number of community diabetes specialist nurses in the county • Development of Diabetes Locality Coordinators, including GPs and practice nurses with a focus on diabetes support • Development of a multi-disciplinary diabetic foot care team who work closely with community podiatry

Ensuring there is parity of esteem for patients During 2018/19 OCCG has continued to focus on parity of esteem, the principle by which mental health is given equal priority to physical health. To this end OCCG commissioned an independent review with its mental health provider, Oxford Health NHS Foundation Trust (Oxford Health), which found that investment in mental health services in Oxfordshire is lower than comparator areas. Relative to other similar clinical commissioning group areas, the county spends less on mental health: 70% of the average. OCCG has the lowest funding allocation per person of any CCG in the country, meaning the county spends around 80% of the average on all other services for the Oxfordshire population. The allocation is worked out centrally on a formula based on the expected needs of the population, and while reviewed periodically it is unlikely to result in OCCG being funded close to national or regional averages in the near future. OCCG and Oxford Health recognise that the amount spent on mental health services should increase, at least to the 80% level of other services within the county and OCCG are working together to manage and address this, along with partners in the wider system locally and nationally. Both organisations recognise that if Oxfordshire is to spend a proper and significant share of its resources on mental health, it will need to spend proportionately less on something else. The overall allocation of resources to OCCG is a factor, as is the county’s relative gap in funding of mental health services specifically.

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While work continues to address the funding issues the latest figures from NHS England rated the performance of health services in Oxfordshire for people with dementia, mental health problems and learning disabilities as 'outstanding' or 'good'.

Improving access to psychological therapies TalkingSpacePlus is the local Improving Access to Psychological Therapies (IAPT) service (a partnership between Oxford Health, Oxfordshire Mind and PML) for anyone age 16+. It provides mental health information and cognitive behavioural therapies for more than 10,000 people. The service saw more than 11,000 people this year to support their mental wellbeing and mild to moderate depression and/or anxiety. The service consistently meets the national targets for waiting times of 75% of people in six weeks and 95% in 18 weeks, and recovery of 50% of those who start therapy. OCCG has increased spend year on year for IAPT, which currently stands at £5.5million a year.

Supporting people with long term conditions to improve their mental health and wellbeing

People with one long term condition are two to three times more likely to suffer from depression or anxiety, and people with more than one condition are seven times more likely. OCCG continues to focus resources on improving access to mental health support for people with physical long term conditions, in particular diabetes, chronic obstructive pulmonary disorder, asthma, cardiac problems and also chronic fatigue syndrome. In 2018/19, patients with irritable bowel syndrome and chronic pain were also being included. In the past year over 2000 people with diabetes, cardiac and respiratory problems have received support for associated mild to moderate depression and anxiety conditions, by improved access to integrated psychological therapies. TalkingSpacePlus has been established within community clinics and working with specialist teams and GP practices to make sure taking account of people’s mental health needs becomes the norm in their physical care plans. Research shows better mental health encourages people to take medication properly. The service is accessed via self-referral via phone or web www.talkingspaceplus.org.uk

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Providing a Safe Haven A new service to support people experiencing a mental health crisis 4 sessions over the weekend (Fri, Sat, Sun, Mon) was launched at the end of March 2018. The service run by the Oxfordshire Mental Health Partnership2 (Mind & Elmore) provides an out-of-hours, non-clinical space in Oxford city centre offering crisis support, signposting, safety planning and listening support. The Oxford Safe Haven (OSH) is open on Friday, Saturday, Sunday and Monday from 6pm until 10pm. Since it opened the service has supported 92 individuals over 911 patient visits. The most common reason for attending OSH was an overall deterioration of the patient’s mental health, closely followed by situational crisis and suicidal ideation. A survey undertaken by those using the service showed that 92% of respondents (361 responses were received) said that they felt they got the support they were looking for on the day. 40% say they would have accessed other urgent and emergency services had the Safe Haven not been available to them.

Improving mental health services for children and young people Children and young people in Oxfordshire will get better access to mental health services after the county was chosen as an NHS 'trailblazer site' by the Government and awarded £5.4m in extra funding until 2021. This new investment, under the Government's Children and Young People’s Green Paper initiative, will be used to pilot reducing waiting times for Child and Adolescent Mental Health Services (CAMHS) to four weeks by 2021. The funding will also support Oxford Health in partnership with Response and Oxfordshire County Council to bring new mental health practitioner teams into primary and secondary schools in Oxford. The new practitioners will be trained via Reading University and funding will support two new pilot Mental Health Support Teams in the first phase.

Supporting new mums’ mental wellbeing OCCG has been successful in securing £800,000 in funding for a new specialist perinatal mental health service for women who have mental health problems during or after their pregnancy. Specialist perinatal mental health services were identified as a gap by the system wide Health Inequalities Commission (2016). Suffering mental health problems can mean poor outcomes for women and their children with wide ranging and lifelong consequences if not treated promptly.

2 Oxfordshire Mental Health Partnership includes Oxford Health, Oxfordshire Mind, Response, Restore, Connections and Elmore.

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An estimated 20% of women develop mental health problems in the perinatal period; the new service will support women with complex cases who have so far not had specialist support. The service will be based in community mental health teams and will work across maternity and community services to provide assessment and intervention for women with moderate to severe mental health problems.

Good practice identified by joint area inspection of Special Education Needs and Disability Service (SEND) A joint area inspection by Ofsted and the Care Quality Commission in 2017 found some exceptional examples of good practice across health services but also some significant areas where improvement was needed. In particular, parents and carers told us that the timeliness and quality of the new Education Health and Care Planning process require ‘Improvement.’ During 2018/19 significant work has been undertaken to make sure that health assessments are written and submitted within the statutory timeframe of six weeks. In addition, training has been rolled out to NHS staff to support them in improving the health assessments. OCCG now has a Designated Clinical Officer for SEND, they are responsible for overseeing the quality improvement programme across NHS services. Part of the role of the Designated Clinical Officer for SEND is to work across the system in Health and provide ‘healthy challenge’ in processes to include SEND. This includes supporting professionals in education to understand the health system. It also involves having an overview of services and making sure that the links either within health or with education are made to drive improvement and secure positive outcome for children and young people with SEND. With the introduction of a Designated Clinical Officer improvements are already being made that are supporting children and young people with SEND. The Clinical Officer has worked with the community dental service, provided by OH, to make adjustments to support young people with SEND to access the service. This has led the service to involve children and parents in designing what resources they would find useful. As a result the service is producing a social story3 film based on a child going to the dentist as well as a child attending for a general anaesthetic. The film will be made available on their website and as a downloadable app for use on an iPad / iPhone or android.

Health and Wellbeing Hub in Rose Hill, Oxford An early pregnancy service was launched in June 2018 at the Rose Hill Community Centre in Oxford. OUH’s Community Early Pregnancy Assessment Unit is for women in the early stages of pregnancy who are in pain, bleeding or having other problems

3 A Social Story can be a written or visual guide describing various social interactions, situations, behaviours, skills or concepts.

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which are concerning them. It is staffed by doctors, nurses and team members who previously provided this service in the Gynaecology Department at the Women's Centre on the John Radcliffe Hospital (JR) site. Through providing early pregnancy care out in the community in a calm and less medicalised environment, women can be supported more sensitively. If women are experiencing problems in their pregnancy, which in some cases can sadly lead to a miscarriage, the service can prevent an unnecessary and potentially upsetting visit to hospital. Rose Hill Community Centre also offers Generation Games Strength and Balance classes for falls prevention. These classes target frail older people and those with Chronic Obstructive Pulmonary Disorder (COPD).

Introduction of growth scan for pregnant women is reducing mortality rate of babies All pregnant women in Oxfordshire are offered a routine dating scan at around 12 weeks and a further anomaly screening scan at 20 weeks. OUH is the only trust in the country to offer a new screening programme to detect babies whose growth is poor later in pregnancy. This includes a 36 week growth scan for all women and additional growth scans for women whose pregnancies are higher risk. The ultrasound scans for this service are based at both the Horton General Hospital (HGH) and the JR. If babies are identified as small at 36 weeks women have the choice of delivering their babies to avoid complications. This has resulted in a reduction in the number of deaths in babies who are born over 24 weeks with no congenital abnormalities of 59% (2017) from 19% (2016).

Reviewing Obstetric Services at the Horton General Hospital Following a referral to the Secretary of State, by the Oxfordshire Health Overview and Scrutiny Committee (HOSC), challenging OCCG’s decision to make permanent a temporary closure of the obstetric unit at the Horton General Hospital and replacing it with a Midwifery Led Unit, OCCG and OUH embarked on a project to review the options and seek feedback from new mums. The work includes a detailed appraisal of options and learning from experiences of mothers, families and staff of maternity services provided in Oxfordshire, ensuring the views of those mothers in South Warwickshire and South Northamptonshire who use these services are also taken into account. As part of this work, the first stakeholder event was held on 22 February 2019. The event was well attended with representation from a wide group of stakeholders across north Oxfordshire, south Warwickshire and south Northamptonshire. Information was shared on the following:

• The clinical model for maternity services in Oxfordshire

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• Planned housing growth and likely impact on population growth • Travel and access • Finance

Participants engaged in discussion about these topics before helping to weight the criteria to be used in assessing the various options for the future.

A survey was also carried out to help us understand the experience of circa 14,000 women who have used maternity services since the temporary closure of the obstetric service at the Horton General Hospital. The survey was open to women in Oxfordshire, south Northamptonshire and south Warwickshire. Over 1000 women and more than 400 partners responded to the survey, analysis will take place following the publication of this report.

Improvements continue following the transition of Learning Disability services to Oxford Health Since the transition, from Southern Health NHS Foundation Trust (Southern Health) to Oxford Health, of specialist health services for people with a learning disability on 1 July 2017, both anticipated and developed improvements to services have benefitted people with learning disabilities and people with autism. Initiatives have taken place across the NHS and OCC as well as by the service provider Oxford Health. These have improved the offer for people with learning disabilities across the Trust’s service areas, as well as delivering more joined-up provision across mainstream secondary healthcare and social care. Oxford Health and OCCG continue to work on the development and implementation of a revised Trust autism strategy and associated implementation plan. This work aims to improve services for people with autism with or without a learning disability, and covers the Trust’s main service areas (beyond the specialist learning disability service). Several initiatives have improved the seamlessness and quality of support from healthcare and social care to people with learning disabilities. Oxfordshire County Council has provided three senior social work practitioners to provide links and expertise between the council and the specialist health service. Oxford Health has developed revised primary care liaison, with advice and guidance provided by the OCCG clinical lead for learning disabilities and autism. This work has included the development of a physical health strategy and implementation plans for each of OCCG’s GP localities. The impact of this work and benefits to patients will be evaluated in 2019/20.

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Joint work with OUH is underway to improve the co-ordination of health care for people with the most complex physical health needs. OUH and Oxford Health have started to develop an improved system-wide mechanism for feedback, which is more fit for purpose and accessible for people with learning disabilities. A senior nurse from the Oxford Health specialist learning disability service is currently on secondment to OUH’s neurology department to develop a pathway for people with learning disabilities and neurological conditions. System-wide mortality reviews are leading to learning and proactive work to address preventable causes of early death, including sepsis and pneumonia. In conjunction with the Oxford Patient Safety Academy a Look@Me project has developed the use of technology to ensure people are safe when they eat.

Specialist Learning Disability Health Service rated ‘good’ by CQC and classed a ‘centre of excellence’ by NHS Improvement

The CQC visited the Oxfordshire specialist learning disability health service, provided by Oxford Health, in March 2018. The service received a rating of good overall seven months post-transfer from South Health. The report stated: “All patients and carers we spoke with described ways in which they had been emotionally supported by the staff team. Patients talked about staff having an in-depth understanding of their individual situations, and the type of emotional support they found most helpful when they were finding things hard. We observed staff interacting sensitively with patients who were experiencing difficulties in coping with specific issues.”

In addition, following a visit from the NHS Improvement (NHSI) Chief Executive in late 2018 the service was declared ‘a centre of excellence’ due to the successful implementation of the NHSI pilot to address new improvement standards. This included questionnaires which indicated that those people who responded felt they were treated with respect 100% of the time and that the majority of respondents agreed they were happy with the care they received.

Tackling winter pressures in the county A fresh approach to tackling the growing pressures of winter across the county’s health and social care system was undertaken in winter 2018/19. Oxfordshire appointed a Winter Director to lead a central team from OCCG, social services, GPs, OUH, Oxford Health, SCAS, voluntary organisations and charities to reduce seasonal pressures and improve quality and performance of emergency and urgent care.

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The aim of the Winter Team was to ensure all health and care professionals in the county worked together to deliver better, responsive and more joined-up services, especially during the flu season. NHS and social care partners are currently evaluating the joint approach, however some of the headline achievements include improved communication and integrated, multi-disciplinary working; there was a 9% increase in acute hospital discharges compared with the previous winter, with an overall reduction in acute length of stay and there were no 12 hour A&E trolley waits. This was a significant improvement from last year. Whilst the health and care system did not meet the national four hour wait target in our main A&E departments (87.5% against a target of 95%), they have been met in the minor injuries units across the county. Health and social care will continue to work together to improve flow through A&E over the coming year. A joint communications campaign was successfully launched to spread the word to patients, public and all NHS and social care staff about the steps everyone can take to prepare their own winter plan. In addition, the campaign targeted local information about Minor Injuries Units, produced a ‘pocket’ guide to services and promoted GP extended hours access hubs. The winter team also continued to reduce the numbers of people “stranded” in hospital when they are medically fit to leave (Delayed Transfers of Care - DToC). Significant progress has been made this year, with a weekly average snapshot of 76 people delayed across acute and community beds. This is down from the 103 in the similar week last year and 187 in 2017. The fall in people being delayed in hospital can be attributed to health and social care working more closely and implementing the following initiatives;

• Integration of Continuing Health Care team into discharge liaison hub • Use of more short-term hub beds to manage pressures • Use of pharmacy support to discharge • Creation of a discharge-to-assess team of therapists in the emergency department and emergency assessment unit • Creation of more home care capacity through reviews of existing packages and incentive schemes to providers • Creation of a step down pathway for vulnerable homeless people • Trusted assessor approaches to support restarts of home care and residential packages and improve timely discharge to

nursing homes.

Improving services in the county’s Accident & Emergency departments OUH bid successfully for £3.2m of additional central Government funding to improve the services in A&E at the JR in Oxford and he HGH in Banbury. At the JR the money has been be used on the following initiatives:

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• Replacement of two old X-ray machines with two new machines in the Trauma Unit • Reconfiguration of the operations centre to an open plan area with increased technology infrastructure to improve the

management of patient flow across the Trust • Improved testing for flu to help identify patients coming to A&E who may already have flu, so infection risk in the hospital can

be controlled. • Six new bays for rapid nurse assessment in A&E (still to be built) • New dedicated mental health suites for the assessment and treatment of adult patients and children and young people with

mental health issues in A&E (still to be built) At the HGH an old x-ray machine has been replaced with a new one in A&E and it also implemented improved testing for flu to identify and manage patients coming into A&E. In addition, a new integrated services hub at the HGH has improved care for patients by supporting their return from hospital. The hub hosts services such as Occupational Therapy, Physiotherapy, Hospital at Home, Stroke Early Supported Discharge, and the Home Assessment Reablement Team (HART). The Early Supported Discharge for Stroke team is a new service development for the HGH, and will support patients to recover through rehabilitation in their own home.

SOS bus helps to alleviate pressure on A&E over festive period The SOS bus, provided by SCAS, returned to Oxford at the end of 2018 to help NHS and emergency services across the city cope with the peak winter and Christmas demand from patients. The SOS service, funded by OCCG, operated from a dedicated Jumbulance vehicle (large ambulance) every Friday and Saturday night (10.45pm to 5am) from Friday 9 November to Sunday 6 January 2018 (5am) in Oxford City Centre. An additional service also ran on New Year’s Eve. Launched in November 2014, the SOS Service is valued by OCCG, SCAS, Oxford Street Pastors, Thames Valley Police and OUH because it provides additional medical provision in the city centre which reduces 999 responses and A&E attendance for alcohol related incidents. 54 patients presented themselves at the SOS Service ambulance for treatment (compared to 63 for the same period 2017/18). Of these, just 16 required further treatment and/or assessment at the John Radcliffe Hospital; which meant the SOS team were able to deal with over two-thirds (70 per cent) of patients at the scene who might otherwise have gone to A&E or called 999.

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Providing care closer to home 2018/19 saw the launch of a three month pilot of the Advanced Nurse Practitioner (ANPs) Outreach Service provided by Oxford Health from the Witney Emergency Multi-disciplinary Unit (EMU)4. It aimed to provide assessment and treatment of acutely unwell frail elderly patients in their usual place of residence to avoid a hospital admission. Patients are referred by GPs and paramedics by phone to the EMU and triaged to the advanced nurse practitioner (ANP) outreach service, if travelling in and out of the unit would constitute a significant burden to the patient. Two prescribing ANPs provided an outreach service five days a week which included point of care tests. They worked with the county’s Hospital at Home team who provided ongoing management of patients with intravenous antibiotics, diuretics, fluids and repeat blood tests. Medical oversight, telephone advice and daily virtual ward round, was provided by a senior GP working in the EMU. Between November to January, 53 patients were visited (17 in care homes) with an average age of 85 years. Seventy two percent remained out of acute hospital for 28 days from referral. The conditions treated by the services included pneumonia, urinary tract infections, bacteraemia, heart failure, acute kidney injury, cellulitis. The pilot will be evaluated in 2019. The Rapid Access Care Unit (RACU) at Townlands Memorial Hospital, in Henley on Thames has been running for over two years now. It provides assessment and treatment of patients with a crisis or deterioration in their health. The service continues to help to reduce A&E attendances and admissions, and has been positively received by the community. Less than 2.23% of patients seen in the RACU needed to be transferred to acute hospital over the last year. Patient feedback is positive with 97.6% likely to recommend the service.

Improving Quality Improving the quality of healthcare provided to people in Oxfordshire is at the heart of OCCG’s work. OCCG does this in many ways. Datix is OCCG’s online quality reporting system which continues to be an effective tool for GPs to report issues to the OCCG and is helping to improve the quality of services. It allows GP feedback to be captured across the 70 practices, enabling the identification

4 The Emergency Multidisciplinary Units (EMUs) at Abingdon and Witney Community Hospitals assess and treat patients on a same-day basis so they do not have to be admitted to a hospital bed.

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of the causes of commonly occurring incidents and trends. OCCG works with providers to prevent them happening again, and to identify problems early to find solutions and improve care for patients. Between April 2018 and 31 March 2019, 1640 items of feedback were reported via Datix. This information is used with information from serious incidents, patient experience and performance data to identify where services and care could be improved. OCCG addresses issues identified and regular progress reports are shared with GPs, providers and the Local Medical Committee (LMC) to show that change is taking place as a result of the feedback, or that OCCG are applying pressure through the service contract where the change is too slow. Another example is working with providers to reduce the number of cases of clostridium difficile (c-difficile). OCCG hosts a monthly Health Economy meeting, attended by OUH, Oxford Health and Public Health England, to discuss all cases of c-difficile from the previous month and to identify whether infections could have been avoided or whether there were lapses in care. Cases found to be avoidable or lapses in care are fed back to the healthcare teams involved to improve practice. Eleven of 1365 cases discussed at Health Economy Meeting (HEM) were found to be avoidable between April 2018 and March 2019. Lapses included inappropriate antibiotic prescribing, delays in sample taking or treatment and documentation. A gradual reduction in both avoidable cases and lapse in care has been recorded through the year. C-difficile cases have seen a decline from 162 in 2017/18 to 126 for 2018/19 as per table below.

5 There were 136 cases discussed at HEMs. 126 There were 126 C.difficile cases apportioned to OCCG in 2018/19; 10 cases will be attributed to OUH but another CCG.

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OCCG has also been working closely with GPs to improve the management of clinical information in practices. In many cases multiple health organisations are involved in the provision of care for patients. This includes GPs as the main coordinator of care, hospitals, local pharmacies and community healthcare services. The complexity of service provision means it is essential to have arrangements in place to manage any potential risks in exchanging information about patient care. OCCG’s Quality team have been looking at this from the point of view of GP practices, with the aim of improving their processes for handling and acting on test results and incoming clinical correspondence. As part of the 2018/19 Primary Care Local Investment Scheme, all Oxfordshire practices have reviewed their current protocols and policies for managing test results and clinical correspondence, carried out audits and spot checks and revised their protocols. GPs and practice managers then shared what they had learned from the process at locality meetings in March, with examples of good practice and innovation highlighted. Several practices involved their Patient Participation Group in reviewing their processes, particularly in relation to test results.

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This complements the ongoing work OCCG is doing with OUH and Oxford Health to improve communication with GP practices. Oxfordshire GPs and practice managers are to be congratulated on the work that they have done on this initiative, which has contributed to improving patient safety and making systems more efficient. OCCG also collects feedback from members of the public about their experiences of healthcare through compliments and complaints, patient experience surveys and provider performance data. Oversight of quality is undertaken at each OCCG Board meeting in public and the Quality Committee, a committee of the Board is chaired by the Lay Member for Public Participation and Involvement (PPI). OCCG has received 102 formal complaints during 2018/19. No complaint was referred to the Ombudsman. When a serious incident (SI) occurs within one of the contracted providers, they are required to report it to OCCG, which ensures an investigation is undertaken by the provider that meets national and contractual timescales. The investigation is reviewed by OCCG to ensure all lessons are learned, and a plan is put in place to prevent reoccurrence. There were 172 serious incidents reported to OCCG between 1 April 2018 and 31 March 2019. This includes one serious incident declared by OCCG on behalf of multiple different organisation involved. Information on how these incidents are disclosed and managed is available in OCCG’s Governance Statement on page 47.

How OCCG are tackling health inequalities OCCG has progressed its work to address health inequalities and improve access to health services, especially for people from the nine protected characteristic groups, as defined in the Equality Act 2010. As part of the Brighter Futures in Banbury programme, Dementia Awareness training has been organised for stakeholders in Banbury, including the Mosque committee members and local Police Community Support Officers. Training was also provided for staff at two Banbury GP Practices. OCCG, with partners, have developed a ‘health literacy’ pack, to be used alongside ESOL (English for Speakers of Other Languages) classes. The pack includes key information on how to register with a GP; other services that can help, such as pharmacies and promoting screening services. The pack is being piloted with current ESOL classes. Sessions with similar information are being delivered to Syrian families as they arrive in Oxfordshire, as part of the Syrian Vulnerable Persons Resettlement Scheme. OCCG has also targeted specific groups to seek feedback through outreach work – this is provided by the Equality and Access Team. They worked with some Black and Minority Ethnic groups to seek views on the Older People’s Strategy consultation and are undertaking a survey with homeless and vulnerable people to find out their views on GP services to help inform re-procurement.

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Team members are also co-ordinating the ongoing Health and Wellbeing Partnerships in the localities in Oxford and participating in the Brighter Futures in Banbury programme, to address health inequalities. Over the last two years, as an active member of the Health Inequalities Commission Implementation Group, OCCG has been working with partners to address 60 recommendations made by the commission (published in December 2016). OCCG and partners hosted the ‘Good Practice Exchange’ event which gave organisations a wider understanding of the health inequalities work going on in the county with a focus on mental health, regeneration and men’s health. Workshops were also run on physical activity, employment and food poverty.

Managing Medicine In 2018/19, OCCG spent £XX million on medicines prescribed by family doctors for the population in Oxfordshire, XX% of its overall budget. As in previous years, there were significant cost pressures on prescribing, however but the CCG’s Medicines Optimisation team have continued to work closely with the GP practices and other clinicians to promote good quality, cost-effective prescribing across the county including minimising spend in areas where there is limited clinical value. The local Minor Ailment Scheme (MAS) provided by some pharmacies in the county has continued to successfully result in a reduction in waiting times and GP workload. Everyone can go to their pharmacist for free advice or to buy medicine for minor illnesses, however the MAS scheme is an NHS service for anyone who does not pay for their prescriptions. Pharmacists are able to give advice and medicines free of charge without the need to see a doctor. In addition, several local community pharmacies now provide advice and treatment to appropriate patients with uncomplicated urinary tract infections (UTIs) using a Patient Group Direction (PGD). Again, the aim of the service is to reduce pressure on GP practices and Out of Hours services by redirecting some patients to a pharmacy. OCCGs dietitian has continued to work closely with practices to review oral nutrition prescribing including sip feeds (liquid oral nutritional supplements), infant milks and gluten free products with the aim of ensuring these are only prescribed according to OCCGs guidance thereby minimising waste and releasing savings which totalled £XXk for the year. Significant work has been done to review the use of dressings in order to manage the choice of products to ensure best care and value for money while also working with community teams to promote appropriate ordering and reduce waste.

Developing a sustainable environment

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OCCG submitted the Sustainable Development Unit (SDU)’s new Sustainable Development Assessment Tool (SDAT) with a 69% overall score in 2018. Areas where OCCG scored highly were sustainable care models and adaptation. Areas where the score was below 50% were carbon/greenhouse gasses and green space and biodiversity. OCCG continued to work with the Centre for Sustainable Healthcare (CSH) and held an Oxfordshire Sustainable Health Economy: Improving Patient Outcomes event in July 2018. The event updated on current progress in Oxfordshire including the following:

• Energy management programme – removing and replacing infrastructure at OUH resulting in a CO2 reduction of 4,748 tonnes in the first six months

• GP social prescribing – aims to improve people’s social connectedness and health outcomes, especially in areas of deprivation, and reduce demand on primary and secondary care services

• Renewable energy – renewable energy projects implemented at Oxford Health NHS Foundation Trust and details of future plans to increase renewables from 1% to 5%

• Sustainability initiatives – within Oxfordshire County Council including energy, waste strategy, natural environment and sustainability

Successful initiatives from other NHS trusts were also shared. Together this provides assurance on a system-wide commitment to continue to improve. OCCG have embedded consideration of sustainable development, climate change adaptation and rural proofing as part of the project management approach. The Agile Working Policy is designed to reduce the negative impact on the environment of staff travelling to and from work and off-site appointments. IT solutions have been rolled out to all staff to support more efficient ways of working that reduce the negative impact on the environment and improve efficiency. As these policies are embedded during 2019/20 further improvements will be delivered. Four Sustainability Champions have volunteered to promote sustainability with staff and several initiatives have been delivered during the year that have resulted in reduced energy consumption. OCCG was recognised for its work in this area by the Sustainable Health and Care Awards receiving ‘Highly Commended’ in the category Sustainable Healthcare Ambassador of the Year.

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How OCCG ensures equality and diversity Under the Equality Act 2010 and the Public Sector Equality Duty (PSED), the NHS and other statutory bodies must show ‘due regard’ to eliminating discrimination. OCCG has applied this ‘due regard’ principle in the form of an equality analysis. This process helps us make fair, robust and transparent decisions based on understanding of the needs and rights of the population, and to ensure OCCGs priorities demonstrate meaningful and sustainable outcomes for the nine ‘protected groups’- age, disability, race, sex, sexual orientation, religion or belief, gender reassignment, marriage and civil partnership and pregnancy or maternity. Equality analysis is a key process used by OCCG to evidence ‘due regard’ of consideration of the nine protected groups in planning and decisions. Copies of some of the completed Equality Analyses can be found on OCCG’s website. OCCG established a countywide group to support providers with the implementation of the Accessible Information Standard providing a forum for sharing resources and good practice. During 2018/19, OCCG continued to build on the excellent work already undertaken and made good progress with the actions arising from the work in implementing the Equality Delivery System (EDS2) and Workforce Race Equality Standard (WRES) where OCCG was able to identify key constraints and gaps. OCCG has a patient Equality Reference Group (ERG) which monitors OCCG’s progress against the action plan, which was developed following the 2018 EDS2 scoring exercise and particularly focuses on the areas where the OCCG is still ‘developing’. A detailed report on how OCCG carries out its duties under the PSED is available in OCCG’s Annual Equality Report 2019.

Responding to an emergency Under the Civil Contingency Act 2004, CCGs have been designated Category Two responders and have a duty to co-operate and share information in an emergency. As a Category Two responder, OCCG has roles and responsibilities in emergency preparedness, resilience and response (EPRR) to:

• Co-operate and share relevant information with Category One responders • Engage in cross-sector planning through Local Health Resilience Partnership • Support NHS England (South East) in discharging its EPRR functions and duties locally • Include relevant EPRR elements in contracts with providers • Ensure that resilience is ‘commissioned in’ as part of standard provider contracts and to reflect risks identified through wider,

multi-agency planning

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• Reflect the need for providers to respond to routine operational pressures (e.g. Winter) • Enable NHS funded providers to participate fully in EPRR exercises and testing programmes as part of the NHS England

(South East) assurance process • Provide commissioned providers with a route of escalation on a 24/7 basis if they fail to maintain their professional levels • Respond to reasonable requests to assist and co-operate • Support NHS England (South East) should any emergency require any NHS resources to be mobilised • Support NHS England (South East) to effectively mobilise all applicable providers that support primary care services should

the need arise. OCCG is responsible for maintaining service delivery across the local health economy to prevent business as usual pressures becoming significant incidents. All CCGs and NHS-funded providers are required to have an Accountable Emergency Officer who can take executive responsibility for leadership for EPRR. In OCCG it is the Director of Governance who holds this executive responsibility. A 24/7 director on call rota is in place to deal with any issues escalated to us by providers and a 24/7 communications on call rota exists for media and communications issues. OCCG was required to assess itself against the NHS Core Standards for EPRR as part of the annual assurance process with NHS England agreeing that OCCG is substantially compliant. An improvement plan was developed setting out required actions to ensure full compliance. OCCG participates regularly in Exercise ‘Talk Talk’, a communication cascade exercise to test the flow of information between emergency responders across the health system in the Thames Valley. OCCG also participated in the following exercises over the past year:

• Director on Call Training sessions designed to share learning as well as working through scenarios • Strategic leadership in a crisis – preparing strategic staff for their role in leading the NHS response to disruptive challenges • Thames Valley Emergency Treatment Centre Workshop – testing plans for setting up an emergency treatment centre • Communications cascade with OCCG staff – testing ability to communication with all staff quickly in an emergency scenario

OCCG has incident response plans in place which are fully compliant with the NHS England Emergency Preparedness Framework 2013. OCCG regularly reviews and makes improvements to its major incident plan and has a programme for regularly testing this plan, the results of which are reported to the Board.

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Earlier this year the Department of Health and Social Care wrote to all providers and commissioners of heath and care services in England sharing EU Exit Operational Readiness Guidance. This guidance sets out the local actions to be taken to prepare for EU exit without a ratified deal to ensure all organisations prepare for and have plans to manage the risks in such a scenario. In line with the Guidance, OCCG has linked with providers, the Local Health and Resilience Partnership and Local Resilience Forum to ensure a co-ordinated approach across the system. A comprehensive action plan is being drawn up to ensure all necessary preparations were undertaken.

Engaging people and local communities OCCG believe that communicating and engaging with its local population is key to achieving its vision. The organisation is committed to putting the patient first and applying the principle of ‘No decision about me without me’ in its commissioning approach. OCCG use the NHS England Principles for Participation to guide its public involvement activities. The population of Oxfordshire is diverse and each community has different needs. It is important for us to understand this diversity to ensure health services are planned properly and provide equity in terms of access, experience and outcomes for everyone. OCCG tailors its engagement materials and activity to enable people with different needs to enable them to participate in the work of OCCG. An example of this was engagement undertaken to seek views on two options for the NHS vasectomy service in Oxfordshire: either to stop it (decommission the service except where there are exceptional circumstances) or alternatively to introduce eligibility criteria. The survey was produced in an easy read format to support responses from people with a learning disability; this group had been identified in the equality analysis for the project. OCCG also ran two focus groups primarily inviting people with a learning disability, families and carers. An analysis of the survey and focus group discussions is currently being undertaken and a report will be published later in early summer. By making sure that the voices of patients, carers and voluntary organisations are heard and that their opinions and suggestions are considered, OCCG are better able to consistently commission high quality services. The experiences and knowledge of patients and the public are at the heart of the decisions OCCG make and are invaluable in identifying areas of waste and key in finding solutions. Listening to people may not always result in the change some people would like. The information, views and experiences shared with OCCG can result in different outcomes. For example:

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• People may tell OCCG about how something should be changed to improve the experience for patients. This then influences change.

• People may tell OCCG how something should be changed to improve the experience for patients but for other reasons (such as clinical safety, financial or workforce constraints) this was not possible.

• People may tell OCCG something that confirms a plan or approach is right and should be continued with confidence.

• People may tell OCCG something is not working or that it needs investigating. If so, OCCG reviews priorities to include this new area of work.

A full report on public involvement activity of OCCG for 2018/19 is available here at the end of May 2019. However, below are a few examples of the impact public involvement has had on planning services.

Joint Older People’s Strategy Together OCCG and OCC, on behalf of the Oxfordshire System, worked together to develop an older people's strategy. The work included joint public engagement throughout the summer of 2018, including a survey and outreach community work to meet and discuss with older people what matters most to them as they age. Following this the draft strategy was consulted upon. Four key areas emerged including loneliness and isolation; keeping active and healthy; access to services; planning and lifestyle. These have been used as key themes in the strategy. The new vision and priorities for the strategy were also co-produced with a wide range of people whose work and lives the strategy affects. This included; members of the public, service users, patients and their families, clinicians, local councillors, commissioning and service managers and third sector organisations.

Developing a primary care decision making tool OCCG embarked on developing a decision making tool for when an existing GP practice contract ends or when significant population growth is planned. This included discussions with a local patient participation group and two workshops to co-produce a process for Oxfordshire to guide OCCGs’ decision-making. The aim was to co-produce a decision-tree using various scenarios and possible options to guide the work. Participants included members from Oxfordshire HOSC, a representative for Witney Town Council, patient representatives, the patient member of Oxfordshire Primary Care Commissioning Committee, Local Medical Committee, NHS England and Healthwatch.

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At the first workshop the various options available to the CCG were considered and scenarios were then discussed in small table groups with the intention of identifying the questions needing to be asked and the possible ordering to create a decision tree. The output of these discussions was taken away and used to create a draft decision tree. A further workshop was organised to review this draft and to test the scenarios. Several changes were made to refine the decision tree. The complexity of the task was acknowledged and it was agreed that the decision tree would be re-drawn to incorporate the necessary changes. Following this a final decision tree was produced and used to inform future primary care provision in the county. The decision making tool is already being used to support the development of different options for the future of South Oxford Health Centre in Oxfordshire.

How does OCCG manage its money?

For the financial year 2018/19, OCCG’s total funding was £899.0m. Of this, £884.3m was allocated for healthcare programmes and £14.7m for the CCG’s running costs. OCCG carried forward a cumulative historic surplus of £24.5m into 2018/19, of which £1.142m was drawn down for use in the year. In setting our financial plans at the start of the year, the CCG complied with all planning requirements and planned to breakeven in year. As set out in the 2018/19 NHS Planning Guidance, CCGs were required to set aside a risk reserve of 0.5% at the start of the year to provide a buffer to offset wider system pressures. All of the risk reserve was required in year to meet programme pressures. The CCG achieved a small surplus of £16k, which means that the CCG achieved its financial plan. This will be added to the historic surplus and £23.4m will be carried forward for drawdown in future years. OCCG has formal delegated responsibility from NHS England for GP Primary Care Commissioning and the CCG received an allocation of £93.8m in order to deliver this. The table below outlines the budget and spend for 2018/19:

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In line with national policy direction for the NHS, Oxfordshire CCG is working more closely with Buckinghamshire and Berkshire West CCGs as part of the wider Buckinghamshire, Oxfordshire and Berkshire West Sustainability and Transformation Programme (BOB STP)6. In addition there is a system approach being adopted across Oxfordshire to mobilise towards a shadow form of Integrated Care System for 2019. This means that organisations work more closely together to make choices and decisions about how the Oxfordshire pound (£) is spent. This enables a more collective approach to risk management and in year risk shares and system agreements were put in place between organisations. In addition, OCCG has continued with joint commissioning and pooled budget arrangements with Oxfordshire County Council (OCC). There were two pooled budgets - the Better Care Fund (BCF) pool and the Adults with Care and Support Needs (ACSN) pool. New risk shares were agreed for each of the two pools during the year.

6 The NHS and local authorities across Buckinghamshire, Oxfordshire and Berkshire West (BOB) are working together to support delivery of the NHS Long Term PLan to deliver better health, better patient care and improved NHS efficiency.

Annual Actual Variance

Budget Month 12 Month 12£'000 £'000 £'000

Acute 433,934 442,950 9,017Community Health 74,302 77,127 2,825Continuing Care 69,550 73,374 3,824Mental Health and Learning Disability 77,411 78,682 1,271Delegated Co-Commissioning 93,765 93,764 (1)Primary care 106,857 104,658 (2,199)Other Programme 16,419 15,835 (584)

Sub Total Programme costs 872,238 886,389 14,151

Running costs 14,698 12,553 (2,145)

Sub Total CCG 886,936 898,942 12,006

Risk Reserve 7,582 0 (7,582)0.5% Contingency reserve 4,440 0 (4,440)Total CCG after contributions to/from reserve 898,958 898,942 (16)

Planned Surplus c fwd 23,406 0 (23,406)

Total 922,364 898,942 (23,422)

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OCCG’s contribution to the pooled budgets was £155m while OCC contributed £194m. During the year OCCG engaged its Internal Auditors to undertake a review of the County Council arrangements in relation to the reported BCF Pool position. A report was received by the Audit Committee providing assurance over the financial processes and controls in place. Further work is being undertaken around the financial control environment for Continuing Healthcare Care reporting. This service is provided to the County Council by Oxford Health NHS Foundation Trust. For the financial year 2019/20, the CCG will receive a £43m increase to funding (£23m in 2018/19). This is a significant increase but is mainly to cover the impact of national tariff changes and pay awards. It should also be considered in the context that Oxfordshire CCG receives the lowest allocation per head of population of all CCG’s in England. The CCG is 4.03% below its target funding level, equating to £32.8m at 2019/20 prices, the 12th lowest in England. (Target funding is the amount a CCG would ideally receive, given the total funding that is available for distribution, to commission services for its resident population.) The CCG continues to identify and implement initiatives that improve the efficiency and value for money of healthcare services in Oxfordshire. There is a savings plan of £20m for 2019/20 and, working with partner health organisations in Oxfordshire, savings will be targeted in the following areas: Right Care[1], demand management, operational changes, service redesign as well as system transformation. The key challenge for OCCG is to meet the health needs of the people of Oxfordshire within the resources available. Improved system working across Oxfordshire and across the wider BOB STP area will contribute to getting the best possible value from the Oxfordshire pound (£).

Managing risk Reducing risk across the health system is a priority for OCCG to ensure patients receive high standards of care. Risks are events or scenarios that can hamper OCCG’s ability to achieve its objectives. These risks, divided into strategic and operational, are identified, assessed and managed by the organisation and reviewed at every OCCG Board meeting in public. They are continually reviewed at Board sub-committee meetings including the Audit Committee, the Finance Committee, the Oxfordshire Primary Care Commissioning Committee, the Quality Committee and the OCCG Executive Committee. In addition Board Committees and OCCG directors review all risks on a bi-monthly basis. The report on OCCG’s principal, strategic and operational risks and mitigations as of 31 March 2019 can be found on OCCGs website here.

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How does OCCG monitor performance? The OCCG Board is responsible for discharging the duties of its constitution, which includes monitoring and scrutinising the performance of service providers. The Board receives an integrated performance report at the bi-monthly meetings in public. Formal committees of the Board scrutinise in more detail how OCCG and health providers are delivering contracted services; these are the Finance Committee, the Audit Committee, Oxfordshire Primary Care Commissioning Committee, the Quality Committee and the OCCG Executive Committee (for more information about the committees and their purpose please see page 49). In addition to the monitoring requirements outlined above, the Accident & Emergency (A&E) Delivery Board also has a role to play in monitoring performance. Its members include the chief operating officers and board level representatives from NHS organisations in Oxfordshire. The group aims to develop and maintain resilience across the urgent care services and improve the flow of patients through A&E, admission, treatment and discharge.

How is OCCG monitored? NHS England has a statutory duty to undertake annual assessment of CCGs. This is undertaken using the Improvement and Assessment Framework (IAF), with the overall assessment derived from CCGs’ performance against the IAF indicators, including an assessment of CCG leadership and financial management. Each CCG receives an overall assessment that places their performance in one of four categories: outstanding, good, requires improvement, or inadequate. OCCG received an overall rating of good in the last set of published assessments for 2017/18. Information on additional performance measures is available on www.nhs.uk/mynhs

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Constitutional targets Below outlines the NHS constitutional targets that OCCG has a duty to meet.

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Accountability Report Corporate Governance Report Members Report Membership Practice Localities and Profiles

North East Oxfordshire: The North East Locality is made up of 7 GP practices covering a registered population of 84,752. The GP Locality Clinical Director is Dr Will O’Gorman who is supported by Deputy Locality Clinical Director Dr Stephen Attwood until 31 March 2019. The 7 practices are: 1. Alchester Medical Group 2. Gosford Hill Medical Centre 3. Islip Surgery 4. Montgomery House Surgery 5. The Health Centre 6. The Key Medical Practice 7. Woodstock Surgery

North Oxfordshire: The North Oxfordshire Locality is made up of 12 GP practices covering a registered population of 113,820. The GP Locality Clinical Director is Dr Shelley Hayles who is supported by Deputy Locality Clinical Director Dr Neil Fisher. The 12 practices are: 1. Banbury Health Centre 2. Bloxham Surgery 3. Chipping Norton Health Centre 4. Cropredy Surgery 5. Deddington Health Centre 6. Hightown Surgery 7. Horsefair Surgery

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8. Sibford Surgery 9. West Bar Surgery 10. Windrush Surgery 11. Woodlands Surgery 12. Wychwood Surgery

Oxford City: The Oxford City Locality is made up of 21 practices covering a registered population of 229,636. The GP Locality Clinical Director is Dr David Chapman who is supported by the following Deputy Locality Clinical Directors, Dr Merlin Dunlop, Dr Karen Kearley and Dr Andy Valentine. The 21 practices are: 1. 19 Beaumont Street 2. 27 Beaumont Street 3. 28 Beaumont Street 4. Banbury Road Medical Centre 5. Bartlemas Surgery 6. Botley Medical Centre (including Kennington Health Centre) 7. Hedena Health (formerly known as Bury Knowle Health Centre and includes Wood Farm Health Centre and Marston Medical

Centre) 8. Donnington Medical Partnership at Donnington Health Centre 9. Cowley Road Medical Practice (formerly known as East Oxford Health Centre) 10. Hollow Way Medical Centre 11. Jericho Health Centre 12. King Edward Street Medical Practice 13. Luther Street Medical Centre 14. Observatory Medical Practice (formerly known as Jericho Health Centre - Dr Kearley) 15. South Oxford Health Centre 16. St Bartholomew's Medical Centre 17. St Clement's Surgery 18. Summertown Health Centre 19. Temple Cowley Health Centre 20. The Leys Health Centre

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21. The Manor Surgery

South East Oxfordshire: The South East Locality is made up of 10 GP practices which cover between them a registered population of 94,721. The GP Locality Clinical Director is Dr Ed Capo-Bianco. The role of Deputy Locality Clinical Director is currently vacant. The 10 practices are: 1. The Bell Surgery 2. Chalgrove and Watlington Surgeries 3. Goring and Woodcote 4. The Hart Surgery 5. Mill Stream Surgery 6. Morland House Surgery 7. Nettlebed Surgery 8. The Rycote Practice 9. Sonning Common Health Centre 10. Wallingford Medical Practice

South West Oxfordshire: The South West Locality is made up of 12 GP practices covering a population of 151,320. The GP Locality Clinical Director is Dr Jonathan Crawshaw the position of Deputy Locality Clinical Director is currently vacant. The 12 practices are: 1. Abingdon Surgery 2. Berinsfield Health Centre 3. Clifton Hampden Surgery 4. Church Street Practice 5. Didcot Health Centre 6. Long Furlong Surgery 7. Marcham Road Surgery 8. Malthouse Surgery 9. Newbury Street Practice 10. Oak Tree Health Centre 11. White Horse Surgery

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12. Woodlands Medical Centre

West Oxfordshire: The West Oxfordshire Locality is made up of 8 GP practices covering a registered population of 82,730. The GP Locality Clinical Director is Dr Miles Carter who is supported by Deputy Locality Clinical Director Dr Amar Latif. The 8 practices are: 1. Bampton Surgery 2. Broadshires Health Centre, Carterton 3. Burford Surgery 4. Charlbury Medical Centre 5. Cogges Surgery 6. The Eynsham Medical Group 7. The Nuffield Practice 8. Windrush Medical Practice, Witney

Members of the Board The names of the Clinical Chair and Chief Executive of OCCG are:

• Dr Kiren Collison, Clinical Chair • Louise Patten, Chief Executive

The Board of OCCG comprises GP representatives, lay members, executive directors and a representative from Public Health. Adult Social Care and an external Medical Specialist. Individual profiles are available on OCCG’s website here. The composition of the Board as of 31 March 2019 includes:

• Dr Ed Capio-Bianco, South East Locality Director • Dr Miles Carter, West Locality Clinical Director • Dr David Chapman, Oxford City Clinical Director • Dr Kiren Collison, Clinical Chair • Dr Jonathan Crawshaw, South West Locality Director

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• Heidi Devenish, Practice Manager Representative at the Summertown Group Practice, Oxford representing the views of practice managers across Oxfordshire

• Roger Dickinson, Lay Member Lead for Governance and Vice Chair, Audit Committee Chair, Remuneration Committee Chair and Lay Member on Oxfordshire Primary Care Commissioning Committee

• Dr Shelley Hayles, North Locality Clinical Director • Diane Hedges, Chief Operating Officer and Deputy Chief Executive • Gareth Kenworthy, Director of Finance • Val Messenger, Interim Director of Public Health, Oxfordshire County Council • Catherine Mountford, Director of Governance • Dr Will O’Gorman – North East Locality Director • Louise Patten, Chief Executive • Dr Guy Rooney, Medical Specialist Advisor • Duncan Smith, Lay Member for Audit Committee, Finance and Investment, Finance Committee Chair and Oxfordshire

Primary Care Commissioning Committee Chair • Kate Terroni, Director of Adult Social Services, Oxfordshire County Council • Professor Louise Wallace, Lay Member for Public Participation and Involvement (PPI) and Quality Committee Chair • Sula Wiltshire, Director of Quality and OCCG Lead Nurse

Statement of Disclosure to Auditors Each individual who is a member of the Board at 31 March 2019 confirms:

• so far as the Board member is aware, that there is no relevant audit information of which the clinical commissioning group’s external auditor is unaware and

• that the Board member has taken all the steps that they ought to have taken as a member in order to make themselves aware of any relevant audit information and to establish that the clinical commissioning group’s auditor is aware of that information.

Please see the Annual Governance Statement on page 47 for information about the committees of the Board including membership and attendance. The Board member Register of Interests is available on the CGGs website here.

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Personal Data Related Incidents There have been no personal data related incidents formally reported to the information commissioner’s office.

Modern Slavery Act OCCG fully supports the Government’s objectives to eradicate modern slavery and human trafficking but does not meet the requirements for producing an annual Slavery and Human Trafficking Statement as set out in the Modern Slavery Act 2015.

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Statement of Accountable Officer’s Responsibilities The National Health Service Act 2006 (as amended) states that each Clinical Commissioning Group shall have an Accountable Officer and that Officer shall be appointed by the NHS Commissioning Board (NHS England). NHS England has appointed Louise Patten to be the Accountable Officer of NHS Oxfordshire CCG. The responsibilities of an Accountable Officer are set out under the National Health Service Act 2006 (as amended), Managing Public Money and in the Clinical Commissioning Group Accountable Officer Appointment Letter. They include responsibilities for:

• The propriety and regularity of the public finances for which the Accountable Officer is answerable, • For keeping proper accounting records (which disclose with reasonable accuracy at any time the financial position of the

Clinical Commissioning Group and enable them to ensure that the accounts comply with the requirements of the Accounts Direction),

• For safeguarding the Clinical Commissioning Group’s assets (and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities).

• The relevant responsibilities of accounting officers under Managing Public Money, • Ensuring the CCG exercises its functions effectively, efficiently and economically (in accordance with Section 14Q of the

National Health Service Act 2006 (as amended)) and with a view to securing continuous improvement in the quality of services (in accordance with Section14R of the National Health Service Act 2006 (as amended)),

• Ensuring that the CCG complies with its financial duties under Sections 223H to 223J of the National Health Service Act 2006 (as amended).

Under the National Health Service Act 2006 (as amended), NHS England has directed each Clinical Commissioning Group to prepare for each financial year financial statements in the form and on the basis set out in the Accounts Direction. The financial statements are prepared on an accruals basis and must give a true and fair view of the state of affairs of the Clinical Commissioning Group and of its net expenditure, changes in taxpayers’ equity and cash flows for the financial year. In preparing the financial statements, the Accountable Officer is required to comply with the requirements of the Group Accounting Manual issued by the Department of Health and in particular to:

• Observe the Accounts Direction issued by NHS England, including the relevant accounting and disclosure requirements, and apply suitable accounting policies on a consistent basis;

• Make judgements and estimates on a reasonable basis;

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• State whether applicable accounting standards as set out in the Group Accounting Manual issued by the Department of Health and Social Care have been followed, and disclose and explain any material departures in the financial statements; and,

• Prepare the financial statements on a going concern basis. To the best of my knowledge and belief, I have properly discharged the responsibilities set out under the National Health Service Act 2006 (as amended), Managing Public Money and in my Clinical Commissioning Group Accountable Officer Appointment Letter. I also confirm that:

• as far as I am aware, there is no relevant audit information of which the CCG’s auditors are unaware, and that as Accountable Officer, I have taken all the steps that I ought to have taken to make myself aware of any relevant audit information and to establish that the CCG’s auditors are aware of that information.

• that the annual report and accounts as a whole is fair, balanced and understandable and that I take personal responsibility for the annual report and accounts and the judgments required for determining that it is fair, balanced and understandable

Louise Patten Accountable Officer XX May 2019

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Governance Statement Introduction and Context Oxfordshire Clinical Commissioning Group is a body corporate established by NHS England on 1 April 2013 under the National Health Service Act 2006 (as amended). The clinical commissioning group’s statutory functions are set out under the National Health Service Act 2006 (as amended). The CCG’s general function is arranging the provision of services for persons for the purposes of the health service in England. The CCG is, in particular, required to arrange for the provision of certain health services to such extent as it considers necessary to meet the reasonable requirements of its local population. As at 1 April 2019, the clinical commissioning group is not subject to any directions from NHS England issued under Section 14Z21 of the National Health Service Act 2006.

Scope of responsibility As Accountable Officer, I have responsibility for maintaining a sound system of internal control that supports the achievement of the clinical commissioning group’s policies, aims and objectives, whilst safeguarding the public funds and assets for which I am personally responsible, in accordance with the responsibilities assigned to me in Managing Public Money. I also acknowledge my responsibilities as set out under the National Health Service Act 2006 (as amended) and in my Clinical Commissioning Group Accountable Officer Appointment Letter. I am responsible for ensuring that the clinical commissioning group is administered prudently and economically and that resources are applied efficiently and effectively, safeguarding financial propriety and regularity. I also have responsibility for reviewing the effectiveness of the system of internal control within the clinical commissioning group as set out in this governance statement.

Governance arrangements and effectiveness The main function of the Governing Body (Board) is to ensure that the group has made appropriate arrangements for ensuring that it exercises its functions effectively, efficiently and economically and complies with such generally accepted principles of good governance as are relevant to it.

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The responsibilities of the Board are detailed in the NHS Oxfordshire Clinical Commissioning Group Constitution. Supporting documents to the Constitution include the Scheme of Delegation, Standing Orders and responsibilities of the members of the Board. Through adoption of the Constitution the Practice Members have agreed that the Board will be responsible for:

• Assurance including audit and remuneration • Assuring the decision-making arrangements • Oversight of arrangements for dealing with conflict of interest • Leading the setting of vision and strategy • Quality • Financial stewardship of public funds • Promoting patient and public engagement • Approving commissioning plans on behalf of OCCG • Monitoring performance against plan • Providing assurance of strategic risks

The Practice Members are represented on the Board through the six Locality Clinical Directors who are appointed in line with their respective Locality Constitutions. In accordance with its Constitution, the Board held six meetings in public in this period. All meetings were quorate in terms of executive and lay member representation. A table of attendance is included in Appendix 1 on page 80. The 2018/2019 Board agenda has focused on organisational objectives, national priorities and the local health economy’s priorities in the Operational Plan. The Board has also held workshops on strategic and corporate objectives. Standing agenda items include The Chief Executives Report, Locality Clinical Director Reports, Integrated Performance Report, Finance Report, Corporate Governance Report, Strategic Risk Register and Board Committee Reports. In addition to the standing agenda items the Board agenda in 2018/2019 has included reporting on:

• Developing OCCGs Approach to Public and Patient Engagement • Safeguarding Annual Report on Mortality Reviews • Children and Young People’s Plan • Health and Wellbeing Board Development and Strategy

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• Planning for Future Population health and Care Needs • Emergency Preparedness Resilience and Response Annual Report • Oxfordshire Safeguarding Adult and Children’s Board Annual Report • EU Exit Operational Readiness • Older People’s Strategy • New Statutory Safeguarding Arrangements

Board Committees Audit Committee The Audit Committee provides an independent and objective view of the proper stewardship of OCCG’s resources and assets by overseeing internal and external audit services, reviewing internal control systems and processes, monitoring compliance with Standing Orders and Prime Financial Policies, reviewing schedules of losses and compensations, reviewing the information prepared to support controls of assurance statements, overseeing risk management arrangements and making recommendations to the Board. The role of the Committee includes integrated governance, statutory reporting and assurance in respect of the principal risks and it will monitor and review the systems and frameworks that are in place to manage organisational risk. The Committee is Chaired by the Vice Chair of the Board with the remaining members comprising a lay member (a qualified accountant), and a Locality Clinical Director. The following officers of OCCG and external representatives are expected to be in attendance: The Director of Finance, the Director of Governance and representatives from internal and external audit. A table of attendance is included at Appendix 1 on page 80. The Audit Committee met four times during 2018/2019. The following internal audits have been received:

• Saving Plan Delivery • Continuing Healthcare • Clinical Leadership • General Data Protection Regulation (GDPR) • Key Financial Controls

The minutes of the Audit Committee are made available to the public with Board papers.

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The Committee has undertaken a self-assessment of its effectiveness using a self-assessment checklist. Actions arising from this self-assessment will be included in the work plan for 2019/2020. An Annual Report of its activity was made to the Board. Finance Committee The remit of the Finance Committee is to develop the financial strategy for OCCG, scrutinise and approve medium term financial plans and the annual budget, monitor in year financial performance and approve the use of contingency reserves. The Committee comprises at least five Board members: two Lay Board members (including at least one qualified accountant), one Locality Clinical Director, the Director of Finance and Chief Operating Officer. The Lay Member (Finance) undertakes the role of Chair. Other members of OCCG management and external advisors may be invited to attend where appropriate. A table of attendance is included in Appendix 1 on page 80. The Finance Committee met seven times during 2018/2019. In addition to standing agenda items reporting on progress on business cases and financial risk, the Committee received reports and updates including:

• Section 75 Performance – Dashboard Review • Estates Bids and Outline Business Cases • Thames Valley and Surrey Local Health and Care Records Exemplar Partnership Agreement • Provider Collaborative Delivery of Services in 2019/2020 • Continuing Healthcare Future Commissioning Intentions • Prescribing Incentive Scheme

The minutes of the Finance Committee are made available to the public with the Board papers. The Committee has undertaken a review of its performance and included the outcome in its annual report to the Board. Quality Committee The role of the Quality Committee is to provide assurance of the quality and performance of services commissioned and to promote a culture of continuous improvement and innovation with respect to safety of services, clinical effectiveness and patient experience. The committee oversees arrangements for safeguarding, co-operating with the local authority in the operation of the Safeguarding Children and Safeguarding Adults Boards. The Quality Committee is Chaired by the lay member with responsibility for patient and public involvement. Members are the Director of Quality, a locality clinical director, Specialist Medical Adviser, Chief Operating Officer and the Director of Governance. Non-voting ex-officio attendees of the committee comprise Clinical Director of Quality, Deputy Director of Quality, Deputy Director

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Joint Commissioning Oxfordshire County Council (OCC), Deputy Director Public Health (OCC) and a patient representative. A table of attendance is included in Appendix 1 page 80. The Quality Committee met six times during 2018/2019 and in addition to standing items on quality and performance reports, risk register, patient experience, clinical effectiveness, safeguarding, inspections and reviews. The committee has received reports and updates on:

• Special Educational Needs and Disability Audit • Safeguarding • Mental Health Homicide Review • Annual Report • CAMHS performance • Infection Control Report and Plan • Annual Medicines Optimisation Report • Serious Incident Report • The Horton Midwifery Led Unit • Musculoskeletal Services • Home Assessment Reablement Team

Remuneration Committee The role of the Remuneration Committee is to advise on appropriate remuneration levels and terms of service for the Executive Team and Clinical Leads. The Committee also sets the framework within which the terms and conditions of senior managers and clinicians are developed and agreed and receives reports on the performance of the Accountable Officer and individual Directors. The Remuneration Committee is Chaired by the Lay Vice Chair of the Board with the Chair and two other lay members making up the membership. The Accountable Officer and Human Resources lead and other external experts are asked to support the Committee as required. The Remuneration Committee met three times during 2018/2019 and fulfilled its remit and responsibilities focusing on:

• Executive Director Remuneration • Director Support to the Chief Executive

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• Substantive appointment of Chief Executive Officer A table of attendance for the meeting is included at Appendix 1 on page 80. Oxfordshire Primary Care Commissioning Committee (OPCCC) The role of the Committee is to carry out the functions relating to the commissioning of primary care medical services in Oxfordshire, including agreeing primary care aspects of the overall OCCG commissioning strategy, providing assurance to the Board and NHS England on quality, performance and finance of all services commissioned from primary care which incorporate the delegated funding and funding from core OCCG allocation, design of local incentive schemes, newly designed enhanced services, approving practice mergers and agreeing and monitoring a financial plan and budget, risk assessment, performance framework and annual workplan. The Committee met four times during 2018/2019. As well as standing agenda items on finance, quality, Head of Primary Care update and risk register the committee has received the following:

• Primary Care Schemes • Prescribing Incentive Scheme • GP Forward View Plan • Annual Report • Developing OPCCC • Review of Locally Commissioned Services • Significant Changes to the General Medical Services (GMS) Contracts in Oxfordshire • Decision Tree for changes in practice circumstances or environment • Priorities for 2019/2020

Executive Committee The role of the Committee is to make recommendations to the CCG Board on strategy and commissioning plans and take day to day decisions on performance management and risk management to provide robust assurance to the CCG Board. The Committee supports the CEO to ensure the CCG fulfils its duties to exercise its functions effectively and monitors and manage delivery of the CCG plan, maintain an oversight of performance and financial position, provide assurance on the management of procurement processes and ensures the CCG has access to the capacity and capability it needs to delivery its functions. Standing items at every meeting are: corporate business – reports from other committees, review of new risks, minutes from the Executive

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Committee’s sub-committees, and escalations to the CCG Board, Programme Board highlight reports, Locality Transformation Highlight reports, strategy setting, corporate risk register. The Committee is chaired by the Chief Executive Officer and members are Clinical Chair, six Locality Clinical Directors, Chief Operating Officer, Director of Finance, Director of Quality, Director of Governance and Interim Director of Transformation. Quorum is at least seven members, four GPs and two other Directors either the Chief Executive or Chief Operating Officer. The committee has met 9 times and in addition to standing items the Committee has received the following:

• Learning Disability Health Checks • Integrated Respiratory Team Pilot • Mission Critical Options List • Contracting Community Services and GP Access • Neighbourhood Development • OPCCC New Ways of Working • Operating Plan Process • Demand Management Modernisation Plan 2019/2020 A table of attendance is included in Appendix 1 on page 80.

UK Corporate Governance Code OCCG is not required to comply with the UK Corporate Governance Code. However, we have reported on our corporate governance arrangements by drawing upon best practice available, including those aspects of the UK Corporate Governance Code we consider relevant to the clinical commissioning group and best practice. This Corporate Governance Report is intended to demonstrate the clinical commissioning group compliance with the principles set out in the Code. For the financial year ended 31 March 2019 and up to the signing of the statement, we complied with the provisions set out in the Code and applied the principles of the Code.

Discharge of Statutory Functions In light of the recommendations of the 1983 Harris Review, the clinical commissioning group has reviewed all of the statutory duties and powers conferred on it by the National Health Service Act 2006 (as amended) and other associated legislative and regulations.

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As a result, I, the accountable officer, can confirm that the clinical commissioning group is clear about the legislative requirements associated with each of the statutory functions for which it is responsible, including any restrictions on delegation of those functions. Responsibility for each duty and power has been clearly allocated to a lead Director. Directorates have confirmed that their structures provide the necessary capability and capacity to undertake all of the clinical commissioning group’s statutory duties.

Other sources of assurance Internal Control Framework

A system of internal control is the set of processes and procedures in place in the clinical commissioning group to ensure it delivers its policies, aims and objectives. It is designed to identify and prioritise the risks, to evaluate the likelihood of those risks being realised and the impact should they be realised, and to manage them efficiently, effectively and economically. The system of internal control allows risk to be managed to a reasonable level rather than eliminating all risk; it can therefore only provide reasonable and not absolute assurance of effectiveness. The Governance Team co-ordinates production of risk registers offers advice and training (when required) and works with Directors via the bi-monthly Directors Risk Review meeting. This meeting is chaired by the Director of Governance and attended by all Directors. The remit of the meeting is to identify new risk areas ensuring they are managed effectively and to review the quality of recording of current risks including an up to date description of the risk rating and providing an overview that all risks are managed appropriately. The Governance Team also maintains the risk cycle ensuring that timely reminders are sent to risk managers for each risk cycle as per Board and sub-committee meetings. Proposed new risks are presented as drafts to the Executive at the Directors Risk Review meeting for approval ahead of inclusion on the risk register. Strategic risks are only closed with approval from the Executive. Operational risks are closed with the approval of a Directorate Head of Service. Annual audit of conflicts of interest management

The revised statutory guidance on managing conflicts of interest for CCGs (published June 2016) requires CCGs to undertake an annual internal audit of conflicts of interest management. To support CCGs to undertake this task, NHS England has published a template audit framework. OCCG’s internal auditors carried out the annual audit of conflicts of interest with an overall assessment of ‘reasonable assurance’. The following were the key findings from the audit:

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• Updated Conflicts of Interest Policy to be published • Declarations of interest checklist to be incorporated into the Conflicts of Interest Policy and disseminated to all committee /

sub-committee Chairs • Register of procurement decisions to include a last updated date • All risk registers to be updated and published on OCCG website • Locality member declarations to be maintained in central location • Requirement to undertake Conflicts of Interest training to be included in the induction checklist

Data Quality

The sourcing of data and management of provider data quality is achieved via contracts. The data contract management processes are well established in Oxfordshire and we continue to capitalize on strong relationships between Commissioning Support Unit, Oxfordshire Clinical Commissioning Group and providers’ information teams to drive improvement. There are two main ways in which data quality is improved:

• Through data quality check routines and data quality improvement targets or programmes • Through consuming the data and feeding the results back to those whose work it represents

There were significant developments in 2018/19 which will bear fruit in the future. Each is detailed below:

Automation drives data quality: The automation of data loading processes into a single data warehouse is increasing the data quality requirements for providers as insufficient quality will simply prevent data submission. The automation of key data processing processes creates capacity for value adding work (see “consuming the data” section below).

Moving to nationally mandated datasets: Up until fairly recently, there were no nationally mandated datasets for community services and no locally accessible nationally mandated dataset for Mental Health services (Other than in aggregated format). There now is a nationally mandated dataset for community, the CSDS and the MHMDS (Mental Health Minimum Dataset) is now fully available via CSU services. As a result, we are decommissioning local datasets and switching to these national data sources. As a result of these transitions, we suspended the data quality work on local datasets and focused on transitioning and will be working on improving data quality for nationally

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mandated data. This will enable us to harness national processes for improvement as well as provide us with data that is comparable across providers (see “consuming the data” section below).

Consuming the data - Population Health Management approaches Most effective to driving data quality improvement is the use of the data and deriving value from using the data the closest to the point of capture as possible. When data is experienced as an asset and is valued, its quality sustainably improves. The move to population health management approaches leads to a different data consumption which will help drive quality improvements. Increasingly cross provider work groups are using the data to understand population segmentation and review how services might be best organised to meet population health needs. There are examples where staffs are now focused on data capture in order to ensure they can benefit from the analytics. This cross provider approach is a departure from the traditional data review within individual contract approaches and is starting to change attitudes. Information Governance

The NHS Information Governance Framework sets the processes and procedures by which the NHS handles information about patients and employees, in particular personal identifiable information. The NHS Information Governance Framework is supported by a data security and protection toolkit and the annual submission process provides assurances to the clinical commissioning group, other organisations and to individuals that personal information is dealt with legally, securely, efficiently and effectively. OCCG places high importance on ensuring there are robust information governance systems and processes in place to help protect patient and corporate information. We have established an information governance management framework and are developing / have developed information governance processes and procedures in line with the data security and protection toolkit. We have ensured all staff undertake annual information governance training and have implemented a staff information governance handbook to ensure staff are aware of their information governance roles and responsibilities. Requirements of the data security and protection toolkit include data flow mapping which is the process of capturing all inbound and outbound data that is valuable to an organisation. An information asset register is also produced logging all the information assets that the organisation holds. Both of these inform the Business Continuity Plans for the organisation and are therefore crucial for the organisations functioning. 2018/2019 saw significant change with the introduction of the General Data Protection Regulation (GDPR) and the new Data Protection Act (DPA) 2018. OCCG developed and implemented an action plan which informed the progress made in each area. OCCG submitted the Data Security and Protection Toolkit which is based on 10 Data Security Standards, and provides assurance

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that GDPR and the DPA 2018 have been implemented. Key developments to ensure compliance with the toolkit included: appointment of a Data Protection Officer (DPO); updating the Privacy Notice on the CCG website; a review of all relevant Policies to ensure they are compliant with the new legislation; embedding Data Protection Impact Assessments (DPIA) within commissioning processes; undertaking a comprehensive Data Flow and Information Assets mapping process and establishing the legal basis under the new legislation. All mandatory assertions within the Data Security and Protection Toolkit were met and the overall assessment was ‘standard met’ which is the required standard. Business Critical Models

The CCG does not own and has not developed any business critical models that have supported its planning in 2018/2019. Our Commissioning Support Unit partner holds models that may be used on our behalf but these have not been used to date. We are aware of the recommendations for public sector made in the Macpherson Report and will apply them as and when we place reliance on business critical models to support the CCG.

Control Issues As identified in the Month 9 Governance Statement return NHS Constitutional requirements are not being met by providers. The A&E Delivery Board is overseeing priorities driven by the Winter Plan and A&E Improvement Plan. Focus continues on reducing stranded patient numbers, creating more bed capacity and improving internal flow between specialties as well as pathway changes. The System wide Winter Team are supporting work to improve flow based at the John Radcliffe Hospital. An elective Care Delivery Programme has been established that meets bi-weekly to review progress against action plans. OUH aimed to reduce 52 week waits to zero in all specialities except Urology and Gynaecology by March 2019. In addition there is ongoing legal and Secretary of State (SoS) referral over the Horton Hospital obstetrics decision. OCCG is working closely with the Horton Health and Overview Scrutiny Committee and delivering agreed plan to address SoS referral. The High Court of Justice dismissed the appeal in the judicial review of the transformation consultation process that took place in early 2017. The original first instance decision made back in December 2017 by Mr Justice Mostyn therefore still stands in OCCG’s favour.

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Counter fraud arrangements The Chief Finance Officer (CFO) is the Executive Board member with responsibility for fraud, bribery and corruption. The CFO approves the annual work plan and liaises with the Local Counter Fraud Specialist in relation to progress against the plan, referrals and other counter fraud issues.

Head of Internal Audit Opinion Following completion of the planned audit work for the financial year for the clinical commissioning group, the Head of Internal Audit issued an independent and objective opinion on the adequacy and effectiveness of the clinical commissioning group’s system of risk management, governance and internal control. The Head of Internal Audit concluded that: Our opinion, based on work undertaken up to 31 March 2019, is set out as follows:

Based on the work undertaken in 2018/19, there is generally a sound system of internal control, designed to meet the CCG’s objectives, and controls are generally being applied consistently. However, during the year we have issued three partial assurance opinions in respect of Collaborative Working, Continuing Healthcare and Incident Management and Cyber Security Follow Up. We have also issued a number of reasonable assurance reports, which highlighted areas for improvement in the control framework.

During the year, Internal Audit issued the following audit reports: Area of Audit Level of Assurance Given

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Collaborative Working Partial Assurance

Continuing Healthcare and Incident Management

Partial Assurance

Cyber Security Follow Up Partial Assurance

Risk Management and Assurance Framework

Reasonable Assurance

Savings Plan Delivery Reasonable Assurance Conflicts of Interest Reasonable Assurance Clinical Quality Governance (Draft) Reasonable Assurance

The Internal Audit of Collaborative Working was conducted at the request of OCCG Audit Committee as the pooled budget arrangements had been highlighted as a potential risk. The Internal Audit Reports for Continuing Healthcare and Cyber Security Follow Up and Incident Management are currently draft and will be received by OCCG Audit Committee in June 2019. Actions to address the recommendations have been developed for all three audits.

Review of the effectiveness of governance, risk management and internal control My review of the effectiveness of the system of internal control is informed by the work of the internal auditors, executive managers and clinical leads within the clinical commissioning group who have responsibility for the development and maintenance of the internal control framework. I have drawn on performance information available to me. My review is also informed by comments made by external auditors in their annual audit letter and other reports. The strategic risk register itself provides me with evidence of the effectiveness of controls that manage risks to the clinical commissioning group achieving its principle objectives have been reviewed.

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I have been guided on the effectiveness of controls through the oversight of the Board and its committees and this has also informed my review. If necessary a plan to addresses weaknesses, for example responses to audit recommendations and ensure continuous improvement of the system in in place.

Conclusion No significant internal control issues have been identified. Louise Patten Accountable Officer XX May 2019

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Remuneration and Staff Report Remuneration Committee Each clinical commissioning group has a Remuneration Committee; the role of the committee is to advise on appropriate remuneration levels and terms of service for the Executive Team and Clinical Leads. Details of membership and terms of reference of the Remuneration Committee are available in on page 51.

Policy on the remuneration of senior managers Senior managers’ remuneration is set through a process that is based on a consistent framework and independent decision-making based on accurate assessments of the weight of roles and individuals’ performance in them. This ensures a fair and transparent process via bodies that are independent of the senior managers whose pay is being set. No individual is involved in deciding his or her own remuneration. Executive senior managers are ordinarily on permanent NHS contracts. The length of contract, notice period and compensation for early termination are set out in the Agenda for Change, NHS terms and conditions of service handbook. All GPs on the OCCG Board have employment contracts and are paid via payroll.

Policy on the remuneration of very senior managers All very senior manager remuneration (VSM) is determined by OCCG’s Remuneration Committee based on available national guidance, benchmarking data against other CCGs and with due regard for national pay negotiations/awards for NHS staff on national terms and conditions. The Remuneration Committee is also cognisant of public sector pay restraint and its responsibility to ensure that executive pay remains publicly justifiable. The Remuneration Committee acknowledges and commits to complying with the requirement to seek pre-approval from NHS England for salaries in excess of £142,500.

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Senior Manager Remuneration (including salary and pension entitlements) 2018/19

Note:

• Louise Patten is seconded from Buckinghamshire CCG so that the remuneration for 2018-19 shown above is a proportion of her total salary. • The CCG receives a contribution towards the costs of Gareth Kenworthy for his role within the STP.

Oxfordshire CCG Taxable benefitAnnual PerformanceLong Term PerformanceAll Pension TOTALTitle Salary & Fees (rounded to Related Bonuses Related Bonuses Related Benefits Oxfordshire CCG

(Bands of £5000) nearest £100) (Bands of £5000) (Bands of £5000) (Bands of £2500)(Bands of £5000)£000 £00 £000 £000 £000 £000

Stephen Attwood Locality Clinical Director 45-50 0 0 0 0-2.5 45-50Ed Capo-Bianco Locality Clinical Director 60-65 0 0 0 10-12.5 70-75Miles Carter Locality Clinical Director 60-65 0 0 0 0-2.5 60-65David Chapman Locality Clinical Director 60-65 0 0 0 0-2.5 60-65Kiren Collison Clinical Chair 90-95 0 0 0 17.5-20 110-115Jonathan Crawshaw Locality Clinical Director 60-65 0 0 0 5-7.5 65-70Heidi Devenish Practice Manager Representative 0-5 0 0 0 17.5-20 20-25Shelley Hayles Locality Clinical Director 110-115 0 0 0 0-2.5 110-115Diane Hedges Chief Operating Officer and Deputy Chief Exective 115-120 0 0 0 15-17.5 130-135Gareth Kenworthy Director of Finance 110-115 0 0 0 7.5-10 120-125Catherine Mountford Director of Governance 100-105 0 0 0 0-2.5 100-105Will O'Gorman Locality Clinical Director 10-15 0 0 0 0-2.5 10-15Paul Park Locality Clinical Director 0-5 0 0 0 80-82.5 85-90Louise Patten Chief Executive 105-110 0 0 0 140-142.5 245-250Guy Rooney Medical Specialist Advisor 10-15 0 0 0 0-2.5 10-15Ursula Wiltshire Director of Quality and Innovation 60-65 0 0 0 0-2.5 60-65

Roger DickinsonIndependent Lay Member, Lead for Governance and Vice Chair 20-25 0 0 0 0-2.5 20-25

Duncan Smith Independent Lay Member, Lead for Finance 15-20 0 0 0 0-2.5 15-20

Louise WallaceIndependent Lay Member, Lead for Patient Participation and Involvement 15-20 0 0 0 0-2.5 15-20

Name

63

Senior Manager Remuneration (including salary and pension entitlements) 2017/18

Note:

• Louise Patten was seconded from Chiltern CCG so that the remuneration for 2017-18 shown above is a proportion of her total salary. • David Smith was Chief Executive until 31 December 2017 • Joe McManners was Clinical Chair until 30 November 2017

Oxfordshire CCG Taxable benefitAnnual PerformanceLong Term PerformanceAll Pension TOTALTitle Salary & Fees (rounded to Related Bonuses Related Bonuses Related Benefits Oxfordshire CCG

(Bands of £5000) nearest £100) (Bands of £5000) (Bands of £5000) (Bands of £2500)(Bands of £5000)£000 £00 £000 £000 £000 £000

Julie Anderson Locality Clinical Director 5-10 0 0 0 0-2.5 5-10Stephen Attwood Locality Clinical Director 60-65 0 0 0 0-2.5 60-65Andew Burnett Locality Clinical Director 0-5 0 0 0 0-2.5 0-5Ed Capo-Bianco Locality Clinical Director 50-55 0 0 0 170-172.5 220-225Miles Carter Locality Clinical Director 60-65 0 0 0 12.5-15 75-80David Chapman Locality Clinical Director 60-65 0 0 0 0-2.5 60-65Kiren Collison Clinical Chair 30-35 0 0 0 0-2.5 30-35Jonathan Crawshaw Locality Clinical Director 55-60 0 0 0 177.5-180 235-240Diane Hedges Chief Operating Officer and Deputy Chief Exective 115-120 0 0 0 22.5-25 140-145Gareth Kenworthy Director of Finance 105-110 0 0 0 25-27.5 135-140Stuart MacFarlane Practice Manager Representative 0-5 0 0 0 0-2.5 0-5Joe McManners Clinical Chair 50-55 0 0 0 22.5-25 70-75Catherine Mountford Director of Governance 100-105 0 0 0 15-17.5 115-120Paul Park Locality Clinical Director 70-75 0 0 0 0-2.5 70-75Louise Patten Chief Executive 30-35 0 0 0 27.5-30 55-60Guy Rooney Medical Specialist Advisor 10-15 0 0 0 0-2.5 10-15David Smith Chief Executive 120-125 0 0 0 0-2.5 120-125Ursula Wiltshire Director of Quality and Innovation 100-105 0 0 0 15-17.5 115-120Mike Delaney Independent Lay Member 5-10 0 0 0 0 5-10

Roger DickinsonIndependent Lay Member, Lead for Governance and Vice Chair 15-20 0 0 0 0 15-20

Duncan Smith Independent Lay Member, Lead for Finance 15-20 0 0 0 0 15-20

Louise WallaceIndependent Lay Member, Lead for Patient Participation and Involvement 10-15 0 0 0 0 10-15

Name

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Pension Benefits as at 31 March 2019

Note:

• Louise Patten - seconded from NHS Buckinghamshire Clinical Commissioning Group • Lay members do not receive pensionable remuneration.

Cash Equivalent Transfer Value A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies. The CETV figures and

Notes

Real increase in pension at

pension age (bands of £2,500)

Real increase in pension

lump sum at pension age

(bands of £2,500)

Total accrued

pension at pension age at 31

March 2019 (bands of £5,000)

Lump sum at pension age related to accrued pension at 31 March

2019 (bands of £5,000)

Cash Equivalent Transfer

Value at 1st April 2018

Real increase in Cash

Equivalent Transfer

Value

Cash Equivalent Transfer

Value at 31 March 2019

Employer's contribution

to stakeholder

pension

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000Stephen Attwood Locality Clinical Director 0 0 0 0 0 0 0 0Ed Capo-Bianco Locality Clinical Director 0-2.5 0-2.5 5-10 10-15 86 24 112 0Miles Carter Locality Clinical Director 0-2.5 0-2.5 0-5 0-5 164 0 0 0David Chapman Locality Clinical Director 0-2.5 0-2.5 40-45 85-90 700 70 791 0Kiren Collison Clinical Chair 0-2.5 0-2.5 15-20 25-30 163 38 207 0Jonathan Crawshaw Locality Clinical Director 0-2.5 0-2.5 10-15 10-15 117 31 151 0Heidi Devenish Practice Manager Representative 0-2.5 0-2.5 2.5-5 0-2.5 21 13 35 0Diane Hedges Chief Operating Officer and Deputy Chief Exective 0-2.5 0-2.5 25-30 50-55 519 87 622 0Gareth Kenworthy Director of Finance 0-2.5 0-2.5 30-35 70-75 443 80 536 0Catherine Mountford Director of Governance 0-2.5 0-2.5 35-40 115-120 775 84 882 0Will O'Gorman Locality Clinical Director 0-2.5 0-2.5 10-15 30-35 171 6 201 0Paul Park Locality Clinical Director 0-2.5 0-2.5 20-25 50-55 182 7 354 0Louise Patten Chief Executive 7.5-10 10-12.5 30-35 45-50 479 108 601 0Ursula Wiltshire Director of Quality and Innovation 0-2.5 0-2.5 0-5 0-5 0 0 0 0

Name Title

65

the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries.

Real Increase in CETV This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period. Pension Benefits as at 31 March 2018

Note:

• Louise Patten - seconded from NHS Chiltern Clinical Commissioning Group • Lay members do not receive pensionable remuneration.

Notes

Real increase in pension at

pension age (bands of £2,500)

Real increase in pension

lump sum at pension age

(bands of £2,500)

Total accrued

pension at pension age at 31

March 2018 (bands of £5,000)

Lump sum at pension age related to accrued pension at 31 March

2018 (bands of £5,000)

Cash Equivalent Transfer

Value at 1st April 2017

Real increase in Cash

Equivalent Transfer

Value

Cash Equivalent Transfer

Value at 31 March 2018

Employer's contribution

to stakeholder

pension

£'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000Ed Capo-Bianco Locality Clinical Director 5-7.5 17.5-20 5-10 20-25 0 89 97 0Miles Carter Locality Clinical Director 0-2.5 0-2.5 10-15 25-30 149 14 164 0David Chapman Locality Clinical Director 0-2.5 0-2.5 35-40 85-90 671 22 700 0Kiren Collison Clinical Chair 0-2.5 0-2.5 5-10 10-15 82 0 77 0Jonathan Crawshaw Locality Clinical Director 7.5-10 7.5-10 10-15 10-15 21 81 109 0Diane Hedges Chief Operating Officer and Deputy Chief Exective 0-2.5 0-2.5 20-25 50-55 461 53 519 0Gareth Kenworthy Director of Finance 0-2.5 0-2.5 30-35 70-75 410 29 443 0Joe McManners Clinical Chair 0-2.5 0-2.5 15-20 30-35 178 15 202 0Catherine Mountford Director of Governance 0-2.5 2.5-5 35-40 110-115 722 46 775 0Paul Park Locality Clinical Director 0-2.5 0-2.5 15-20 40-45 262 0 249 0Louise Patten Chief Executive 0-2.5 0-2.5 20-25 30-35 432 11 479 0Ursula Wiltshire Director of Quality and Innovation 0-2.5 2.5-5 35-40 110-115 0 0 0 0

Name Title

66

Workforce Remuneration: Multiple Pay Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation’s workforce. The banded remuneration of the highest paid director/member of the OCCG Board in the financial year 2018/19 was £155-£160k (2017/18 was £155k to £160k) on an annualised basis. This was 3.3 times (2017/18 3.2 times) the median remuneration of the workforce, which was £47,798 (2017/18 £48,514). In 2018/19, 1 employee (2017/18 no employees) received remuneration in excess of the highest paid director/member of the OCCG Board. Remuneration ranged from £3,000 to £180,000 (2017/18 £13,000 to £157,000). Total remuneration includes salary, non-consolidated performance-related pay and benefits-in-kind. It does not include severance payments, employer pension contributions and the cash equivalent transfer value of pensions.

Staff Report Staff sickness absence Below outlines OCCG’s sickness absence data from 1 April 2018 to 31 March 2019.

2016/17 2017/18 2018/19

Total Days Lost

533

594

Data to

follow

Average full time equivalent

89

94.5

Average working Days Lost

6.0

6.3

67

Sickness absence is managed in a supportive and effective manner by OCCG managers, with professional advice and targeted support from human resources (HR), occupational health, employee assistance programme and staff support services which are appropriate and responsive to the needs of our workforce. OCCG’s approach to managing sickness absence is governed by a clear HR policy and this is further supported by the provision of HR advice and training sessions for all line managers on the effective management of sickness absence. OCCG proactively promotes the health and wellbeing of staff in line with the Health and Wellbeing Policy through a programme of initiatives. Events are organised throughout the year and have included a running and walking club, Christmas decoration competition, Christmas quiz, awareness raising campaigns, charity triathlon and a cycle to work scheme. The work is supported by a team of health and wellbeing champions. Managers ensure that the culture of sickness reporting is embedded within their teams and sickness absence is actively monitored and formally reported to OCCG on a quarterly basis as part of the workforce reporting process.

Staff numbers and gender analysis OCCG has a workforce comprised of employees from a wide variety of professional groups. At the end of 2018/19 OCCG employed 114 staff (headcount), of which 86 were women and 28 men. As of 31 March 2019, the Board of OCCG was made up of 5 women and 3 men. Below is a breakdown of gender analysis. The membership body of OCCG is made up of all 70 (as at 31 March 2019) GP practices within Oxfordshire; a breakdown of membership by gender is not available. Below outlines the gender breakdown of staff:

Female Headcount

Male Headcount

Total Headcount

CEO and Board 5 3 8

Very Senior Managers including GPs

8 13 21

All other Employees 73 12 85

Total Employees 86 28 114

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The below table shows average number of people (headcount) employed by OCCG, which equated to an average of 83 whole time equivalent staff.

2018/ 2019 Permanently

employed Number

Other Numbers 2018/2019 Total Number

Total 89 29 118

Of the above: Number of whole time equivalent (WTE) people engaged on capital projects

0 0 0

Trade union official facility time OCCG has one trade union representative who worked 31.5 facility hours during 2018/19 at a cost of £571. Number of employees who were relevant union officials during the relevant period

Full-time equivalent employee number

1 0.6WTE Percentage of time Number of employees 0% 0 1-50% 1 51%-99% 0 100% 0

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Percentage of pay bill spent on facility time Provide the total cost of facility time £571 Provide the total pay bill 21245 Provide the percentage of the total pay bill spent on facility time, calculated as: (total cost of facility time ÷ total pay bill) x 100

2.7%

Time spent on paid trade union activities as a percentage of total paid facility time hours calculated as: (total hours spent on paid trade union activities by relevant union officials during the relevant period ÷ total paid facility time hours) x 100

2.7%

Expenditure on consultancy Expenditure on consultancy was £250k in 2018/2019 (£1,188k in 2017/18) as per Note 5 to the Accounts page XX.

Off Payroll Engagements

i. Under Treasury guidance PES (2013) 09, all public sector organisations are required to disclose information about high paid off payroll appointments. As at 31 March 2019 there were no off payroll engagements for more than £245 per day.

ii. The CCG did not have any new off payroll engagements, or any that reached six months in duration, which cost more than £245 per day, between 1 April 2018 and 31 March 2019.

iii. For any off-payroll engagements of Board members and / or senior officials with significant financial responsibility, between 01 April 2018 and 31 March 2019.

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Number of off-payroll engagements of board members, and/or senior

officers with significant financial responsibility, during the financial

year (1)

0

Total no. of individuals on payroll and off-payroll who have been

deemed “board members, and/or, senior officials with significant

financial responsibility”, during the financial year. This figure should

include both on payroll and off-payroll engagements. (2)

5

There were no non-contractual severance payments made following judicial mediation, and no payments relating to non-contractual payments in lieu of notice.

Exit Packages 2018/19 There were no exit packages in the year 2018/19 and consequently no associated payments.

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Exit Packages 2017/18 Exit packages cost (inc

special payment element

Compulsory redundancies

Number

Compulsory redundancies

£s

Other agreed departures

Number

Other agreed departures

£s

Total

Number

Total

£s

Departures where special

payments have been

made

Number

Departures where special

payments have been

made

£s

Less than £10,000 0 0 0 0 0 0

£10,001 to £25,000 1 8,000 0 0 1 8,000 0 0

£25,001 to £50,000 0 0 0 0 0 0 0 0

£50,001 to £100,000 0 0 0 0 0 0 0 0

£100,001 to £150,000 0 0 0 0 0 0 0 0

£150,001 to £200,000 0 0 0 0 0 0 0 0

Over £200,001 0 0 0 0 0 0 0 0

Total CCG 1 8,000 0 0 1 8,000 0 0

Analysis of Other Agreed Departures There were no departures made in the year 2018/19 or the previous year 2017/18 in respect of voluntary redundancy, ill health retirements, mutually agreed resignations, early retirements in the efficiency of the service, payments in lieu of notice, exit payments following employment tribunals or court orders or non-contractual payments requiring HMT approval.

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Redundancy and other departure costs would be paid in accordance with the provisions of OCCG’s Compulsory Redundancy Scheme in line with Agenda for Change standard entitlements where applicable. Any exit costs are accounted for in accordance with relevant accounting standards and at the latest in full in the year of departure. OCCG has not agreed any early retirements. If it had, the additional costs would be met by OCCG and not by the NHS Pension Scheme, and would be included in the tables. Ill-health retirement costs are met by the NHS Pension Scheme and are not included in the tables. No non-contractual payments (£0) were made to individuals where the payment value was more than 12 months of their annual salary. The Remuneration Report would include the disclosure of exit payments payable to individuals named in that Report. There were none during 2018/19.

Staff Policies OCCG recognise and value the importance of maintaining positive working relationships with its staff and their representatives. The Staff Partnership Forum (SPF) is its joint management and staff forum for staff engagement and consultation. OCCG have actively and successfully worked in partnership on a number of issues affecting staff including the development and review of human resources policies. Policies are ratified by OCCG’s Executive prior to publication. The SPF is representative of the workforce and OCCG recognises all of the trade unions outlined in the national NHS Terms and Conditions of Service Handbook who have members employed within the organisation. OCCG has a Health and Wellbeing Policy and an active, staff led, Health and Wellbeing Group which is responsible for the implementation of this policy. Events are held throughout the year with a large number of staff participating. Events have included fund raising activities and events to celebrate the NHS 70th Birthday. OCCG with its SPF have developed a range of methods to communicate and encourage meaningful, two-way dialogue with staff include:

• Monthly staff briefings led by the Executive Team which includes a question and answer session • Monthly staff newsletter • Staff surveys to drive improvement in staff experience • Corporate website and intranet

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• Staff development sessions The results of the staff survey were assessed by the SPF, themes identified and an action plan developed by staff to address different aspects of the feedback. This has resulted in the development of a more agile working approach and focus on OCCG values. Managers hold regular one-to-one meetings with staff and use the values based appraisal system ensuring all staff work towards clearly defined personal objectives and standards of behaviour. These are supported with learning, training and development opportunities detailed in individual Personal Development Plans. The Organisational Development (OD) Steering Group was established to oversee the implementation of the internal OD plan. Following the development of OCCG’s vision and values and the supporting behavioural framework all staff were appraised using a values based approach. The OD Steering Group have developed a People and OD Plan enabling OCCG to make informed choices around funding and resourcing for developing the workforce and attracting, developing and retaining key talent within the organisation. The Apprenticeship Levy is being utilised to support Project Management Training as this was identified through appraisals as a development need for a number of staff.

Disability information OCCG has developed an integrated approach to delivering workforce equality so it does not have a separate policy for disabled employees or for any other protected characteristics. Equalities issues are incorporated in policies covering all aspects of the employee lifecycle ranging from recruitment to performance. OCCGs aim is to provide an environment in which all staff are engaged, supported and developed throughout their employment and to operate in ways which do not discriminate our potential or current employees by virtue of any of the protected characteristics specified in the Equality Act 2010. OCCG is also committed to supporting employees to maximise their performance including making any reasonable adjustments that may be required on a case by case basis. OCCG is committed to implementing the Workforce Race Equality Standards (WRES) and will work with those organisations it commission services from and partners to ensure employees from black and ethnic minority backgrounds have equal access to career opportunities and receive fair treatment in the workplace. OCCG will also work with these organisations around the implementation of the Workforce Disability Equality Standards which will be introduced during 2019. The 2018 WRES return is available on the CCGs website here

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Equality and Diversity For a full account of the Workforce Race Equality Standard and how we give ‘due regard’ to eliminating discrimination please see page 29 of this report. Information is also available on www.nhs.uk/mynhs

Health and safety OCCG recognises that the maintenance of a safe work place and safe working environment is critical to our continued success and accordingly, we view our responsibilities for health, safety and welfare with the upmost importance. OCCG requires all workers to equally accept their responsibilities as part of the development of a true safety culture and we aim to ensure the achievement of high standards in relation to the provision of health and safety arrangements and the continued development of the safety culture and the well-being of staff. OCCG’s health and safety policy covers display screen equipment, fire safety, first aid, manual handling, lone working, new and expectant mothers and work related stress. Health and Safety training forms part of the suite of statutory and mandatory training which is undertaken by all employees.

Whistleblowing Oxfordshire CCG has a whistleblowing policy that is communicated to all staff and available on the CCG staff intranet.

Auditable elements Please note that the elements of this remuneration and staff report that have been subject to audit are the analysis of staff numbers and gender analysis and related narrative notes on pages 67, the tables of salaries and allowances of senior managers and related narrative notes on page 62 and 67, pension benefits of senior managers and related narrative on pages 64 and 65, exit packages and related narrative on pages 70 and 71 and the pay multiples and related narrative notes on page 66. Louise Patten Accountable Officer XX May 2019

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Parliamentary Accountability and Audit Report Oxfordshire Clinical Commissioning Group is not required to produce a Parliamentary Accountability and Audit Report but has opted to include disclosures on remote contingent liabilities, losses and special payments, gifts, and fees and charges in this Accountability Report. For 2018/19 there is nothing to disclose. An audit certificate and report is also included in this Annual Report (see page 76). INSERT FINAL TABLE Louise Patten Accountable Officer XX May 2019

76

Independent Auditor’s Report to the Members of the Board of Oxfordshire Clinical Commissioning Group

77

Glossary of Terms

Buckinghamshire, Oxfordshire and Berkshire West Sustainability & Transformation Partnership (BOB STP): The NHS and local authorities across Buckinghamshire, Oxfordshire and Berkshire West are working together to support delivery of NHS England’s Five Year Forward View to deliver better health, better patient care and improved NHS efficiency.

Care Quality Commission: monitors, inspects and regulates hospitals, care homes, GP surgeries, dental practices and other care services to make sure they meet fundamental standards of quality and safety

Clinical Chair: medical doctors at the head of Oxfordshire Clinical Commissioning Group. GP Federation: a group of GP practices which come together to provide a greater range of services to patients in their local area eg OxFed

Health and Wellbeing Board (HWB Board): key leaders from the health and social care services and Healthwatch work together to improve the health and wellbeing of their local population and reduce health inequalities

Healthwatch: UK consumer watchdog for patients which aims to improve health and social care

Joint Strategic Needs Assessment for Oxfordshire: provides information about the county’s population and the factors affecting health, wellbeing, and social care needs.

Local Health Resilience Partnership: a group for local health organisations (including private and voluntary sector where appropriate) which looks at readiness and planning for major health emergencies

Local Medical Committee: a statutory body for local GPs which looks after the interests of family doctors

Locality Plans: intended to build resilient, sustainable primary care for the future based on local need. The plans are intended to support the vision for health services where patients will receive more care closer to home and be supported out of hospital as much as possible.

78

Medicines Optimisation Team: helps health professionals and patients make the right treatment and medicines choices by promoting cost effective and evidence based clinical practice and effective risk management

Mental Health Partnership: The Mental Health Partnership comprises Oxford Health Foundation Trust, Oxfordshire Mind, Restore, Response, Connection Floating Support and Elmore Community Services

National Institute for Clinical Excellence: provides national guidance and advice to improve health and social care. It aims: • to help medical practitioners deliver the best possible care • to give people the most effective treatments based on the latest evidence • to provide value for money • to reduce inequalities and variation NHS Long Term Plan: The NHS Long Term Plan, published in January 2019, is a 10 year plan for the NHS to improve the quality of patient care and health outcomes. Its ambitions include measures to prevent 150,000 heart attacks, strokes and dementia cases, and better access to mental health services for adults and children.

Oxford Health Foundation Trust (OHFT): provides physical, mental health and social care for people of all ages across Oxfordshire, Buckinghamshire, Swindon, Wiltshire, Bath and North East Somerset. Its services are delivered at community bases, hospitals, clinics and people’s homes.

Oxford University Hospitals NHS Foundation Trust (OUHFT): is one of the largest teaching hospitals in England. It is made up of four hospitals - the John Radcliffe Hospital, the Churchill Hospital and the Nuffield Orthopaedic Centre, all in Oxford, and the Horton General Hospital in Banbury. It provides a wide range of clinical services, specialist services (including cardiac, cancer, musculoskeletal and neurological rehabilitation), medical education, training and research.

Oxfordshire Joint Health and Wellbeing Strategy: The story of how the NHS, councils and Healthwatch work together to improve the health and wellbeing of people in Oxfordshire. The strategy has been developed with input from the people of Oxfordshire.

Oxfordshire Joint Health Overview Scrutiny Committee: looks at the work of the NHS clinical commissioning groups, healthcare trusts, and the NHS England Local Area Team. The committee acts as a 'critical friend' by suggesting ways that health related services might be improved.

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Patient Participation Groups (PPG): patient representatives from a GP practice who advise and inform the practice on what matters most to patients and to help identify solutions to problems as a ‘critical friend’

Primary Care: most people’s first point of contact with health services, for example, GPs, dentists, pharmacists or optometrists

Primary Care Networks: Primary care networks bring general practices together to work at scale. This helps to recruit and retain staff; manage financial and estates pressures; provide a wider range of services to patients and to more easily integrate with the wider health and care system. All GP practices are expected to come together in geographical networks covering populations of approximately 30–50,000 patients by June 2019.

Referral to Treatment Times: the period of time from referral by a GP or other medical practitioner to hospital for treatment in the NHS

South Central Ambulance NHS Foundation Trust (SCAS): SCAS provides and accident and emergency service to respond to 999 calls; the NHS 11 service for when medical help is needed fast but not a 999 emergency and a non-urgent patient transport service. It covers the counties of Berkshire, Buckinghamshire, Hampshire and Oxfordshire.

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Appendix A: Table of Attendance for Board and Committee Meetings (Membership in line with Constitution dated 14 January 2016) Board

Name 24/05/2018 26/07/2018 27/09/2018 29/11/2018 31/01/2019 28/03/2019 Patten, Louise Apols Collison, Kiren Apols Attwood, Stephen Apols Apols Capo-Bianco, Ed Carter, Miles Apols Chapman, David Crawshaw, Jonathan Dickinson, Roger Hayles, Shelley Apols Kenworthy, Gareth Apols O’Gorman, Will N/A N/A N/A N/A N/A Rooney, Guy Apols Smith, Duncan Apols Wallace, Louise Wiltshire, Sula Apols

Audit Committee

Name 22/05/2018 19/06/2018 18/10/2018 21/02/2019 Carter, Miles Apols Apols Dickenson, Roger Kenworthy, Gareth Mountford, Catherine Smith, Duncan

81

Finance Committee Name 24/05/2018 17/07/2018 31/08/2018 25/09/2018 22/11/2018 29/01/2019 05/03/2019 Capo-Bianco, Ed Apols Apols Apols Dickinson, Roger Hedges, Diane Apols Kenworthy, Gareth Patten, Louise Apols Apols Apols Apols Apols Smith, Duncan

Quality Committee

Name 26/04/2018 28/06/2018 30/08/2018 15/11/2019 20/12/2018 28/02/2019 Chapman, David Hedges, Diane Apols Apols Mountford, Catherine Apols Rooney, Guy Apols Apols Apols Apols Wallace, Louise Wiltshire, Sula

Remuneration Committee

Committee Member 26 July 2018 25 October 2018 22 January 2019 Kiren Collison Roger Dickinson Duncan Smith Louise Wallace

82

Oxfordshire Primary Care Commissioning Committee Name 01/05/2018 04/09/2018 06/11/2018 05/03/2019 Collison, Kiren Apols Apols Dickinson, Roger Hedges, Diane Mountford, Catherine Apols Patten, Louise Apols Apols Paul, Meenu Apols Apols Smith, Duncan Apols

Executive Committee

Name 24/07/2018 28/08/2018 25/09/2018 23/10/2018 27/11/2018 18/12/2018 22/01/2019 26/02/2019 26/03/2019 Attwood, Stephen Apols N/A Capo-Bianco, Ed Apols Carter, Miles Apols Apols Apols Apols Chapman, David Cogswell, Jo Collison, Kiren Apols Crawshaw, Jonathan

Apols Apols Apols

Hayles, Shelley Apols Hedges, Diane Apols Apols Kenworthy, Gareth Apols Mountford, Catherine

Apols

O’Gorman, Will N/A N/A N/A N/A N/A N/A N/A N/A Patten Lou Apols Apols Wiltshire, Sula Apols Apols Apols